Provider Demographics
NPI:1568578797
Name:ISTAS, JOEDY R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEDY
Middle Name:R
Last Name:ISTAS
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 1:7100 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2714
Mailing Address - Country:US
Mailing Address - Phone:402-506-9000
Mailing Address - Fax:402-506-9093
Practice Address - Street 1:7100 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2714
Practice Address - Country:US
Practice Address - Phone:402-506-9000
Practice Address - Fax:402-506-9093
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731795Medicaid
NE47068731734Medicaid
NE47068731749Medicaid
IA0949693Medicaid
NE10025302200Medicaid
NE47068731741Medicaid
B90824Medicare UPIN
NE47068731795Medicaid