Provider Demographics
NPI:1376654780
Name:FISCHER, JERRY L (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2626
Mailing Address - Country:US
Mailing Address - Phone:402-341-7761
Mailing Address - Fax:402-341-4841
Practice Address - Street 1:2665 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2626
Practice Address - Country:US
Practice Address - Phone:402-341-7761
Practice Address - Fax:402-341-4841
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13846207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2930982Medicaid
IA53577OtherBCBS IA
NE470781645Medicaid
30966OtherBCBS NE
NE470781645OtherTRICARE
461OtherMIDLANDS CHOICE
IAP00673790OtherRAILROAD MEDICARE
30966OtherBCBS NE
IA390003969Medicare PIN
D17263Medicare UPIN
NENA1910002Medicare PIN