Provider Demographics
NPI:1326057571
Name:PASSER, JEFFREY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:PASSER
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 1:10170 NICHOLAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2174
Mailing Address - Country:US
Mailing Address - Phone:402-391-3800
Mailing Address - Fax:402-391-2422
Practice Address - Street 1:10170 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2174
Practice Address - Country:US
Practice Address - Phone:402-391-3800
Practice Address - Fax:402-391-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12482207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
470626790OtherFED TAX ID
NENA2227001OtherMEDICARE PTAN
NE47062679000Medicaid
470626790OtherFED TAX ID