Provider Demographics
NPI:1255302212
Name:WEREMY, JOHN M (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:WEREMY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 S 172ND AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3250
Mailing Address - Country:US
Mailing Address - Phone:402-740-6772
Mailing Address - Fax:402-294-5112
Practice Address - Street 1:2501 CAPEHART RD
Practice Address - Street 2:
Practice Address - City:OFFUTT AFB
Practice Address - State:NE
Practice Address - Zip Code:68113-1043
Practice Address - Country:US
Practice Address - Phone:402-294-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE244213E00000X
IA00618213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1255302212OtherNPI
480032322OtherPALMETTTO GBA - RAILROAD
IA1139303Medicaid
NE47082426700Medicaid
NE47082426700Medicaid
NE267418Medicare PIN
480032322OtherPALMETTTO GBA - RAILROAD