Provider Demographics
NPI:1609839422
Name:FELT, JONATHAN Q (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:Q
Last Name:FELT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:Q
Other - Last Name:FELT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7601 PIONEERS BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-4675
Mailing Address - Country:US
Mailing Address - Phone:402-484-6677
Mailing Address - Fax:402-484-4476
Practice Address - Street 1:7601 PIONEERS BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-4675
Practice Address - Country:US
Practice Address - Phone:402-484-6677
Practice Address - Fax:402-484-4476
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE220542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE275247OtherAMI MEDICARE PIN
NENA1330017OtherSMI MEDICARE PIN
NE47078180813Medicaid
NE275312Medicare PIN
NENA1330017OtherSMI MEDICARE PIN