Provider Demographics
NPI:1568400059
Name:JERABEK, THOMAS J (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:JERABEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4438
Mailing Address - Country:US
Mailing Address - Phone:402-371-4880
Mailing Address - Fax:402-644-7647
Practice Address - Street 1:2700 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4438
Practice Address - Country:US
Practice Address - Phone:402-371-4880
Practice Address - Fax:402-644-7647
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE465207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098713OtherMEDICARE-IMC/BERGAN
NE10025709900Medicaid
IAI21224OtherMEDICARE-MERCY
NE10025745600Medicaid
NE47055043813Medicaid
NENA1324OtherMEDICARE-MIDLANDS
IA10025507800Medicaid
NE10025745600Medicaid
IAI21224OtherMEDICARE-MERCY
NE098713OtherMEDICARE-IMC/BERGAN