Provider Demographics
NPI:1356306005
Name:KNERL, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:KNERL
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 1:111 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:PONCA
Mailing Address - State:NE
Mailing Address - Zip Code:68770
Mailing Address - Country:US
Mailing Address - Phone:402-755-2231
Mailing Address - Fax:402-755-4100
Practice Address - Street 1:111 SECOND STREET
Practice Address - Street 2:
Practice Address - City:PONCA
Practice Address - State:NE
Practice Address - Zip Code:68770
Practice Address - Country:US
Practice Address - Phone:402-755-2231
Practice Address - Fax:402-755-4100
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0928127Medicaid
153OtherMIDLANDS
22009OtherBCBS OF NEBRASKA
NE421059182 14Medicaid
92878OtherWELLMARK BCBS OF IA
NE265299Medicare ID - Type Unspecified
92878OtherWELLMARK BCBS OF IA
IAI1284Medicare ID - Type Unspecified