Provider Demographics
NPI:1548201643
Name:WEITZMANN, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WEITZMANN
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 1:110 N 29TH ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4424
Mailing Address - Country:US
Mailing Address - Phone:402-844-8121
Mailing Address - Fax:402-844-8122
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:STE. 303
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4461
Practice Address - Country:US
Practice Address - Phone:402-844-8131
Practice Address - Fax:402-844-8130
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23007207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00192908OtherRR
NE06222OtherBCBSNE
NEH88749Medicare UPIN