Provider Demographics
NPI:1316041734
Name:SHEHAN, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:SHEHAN
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 1:12910 PIERCE ST
Mailing Address - Street 2:STE 120
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-1106
Mailing Address - Country:US
Mailing Address - Phone:402-933-3770
Mailing Address - Fax:402-916-4662
Practice Address - Street 1:12910 PIERCE ST STE 120
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-1106
Practice Address - Country:US
Practice Address - Phone:402-933-3770
Practice Address - Fax:402-916-4662
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22767207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1497182273Medicaid
NE100263840-00Medicaid
IA558460001Medicare PIN
NE277801Medicare PIN
NE086159Medicare PIN
IA55846Medicare PIN
NE100263840-00Medicaid
IAI21551Medicare PIN
IA1497182273Medicaid
NEP00309931Medicare PIN
IA44836Medicare PIN