Provider Demographics
NPI:1164520433
Name:LERNER, GARY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:LERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 DODGE STREET
Mailing Address - Street 2:CHILDREN'S HOSPITAL
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-5400
Mailing Address - Fax:
Practice Address - Street 1:8200 DODGE STREET
Practice Address - Street 2:CHILDREN'S HOSPITAL - HOSPITALISTS
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-4496
Practice Address - Fax:402-955-3674
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14910208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025138400Medicaid
NE1201616OtherSHARE ADVANTAGE
NE487OtherMIDLANDS CHOICE
MO206946113Medicaid
NE06288OtherBCBS
IA1956987Medicaid
NE47037975441Medicaid