Provider Demographics
NPI:1346318250
Name:LEAR, ANDREW J (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:LEAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:J
Other - Last Name:LEAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:2404 HARDISON DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3417
Mailing Address - Country:US
Mailing Address - Phone:402-841-5293
Mailing Address - Fax:
Practice Address - Street 1:2404 HARDISON DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3417
Practice Address - Country:US
Practice Address - Phone:402-841-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE545363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099724002Medicare PIN
S49636Medicare UPIN