Provider Demographics
NPI:1639177009
Name:DREYER, STEPHEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:DREYER
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 1:2830 N CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-7718
Mailing Address - Country:US
Mailing Address - Phone:402-721-6333
Mailing Address - Fax:402-721-6320
Practice Address - Street 1:2830 N CLARKSON ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-7718
Practice Address - Country:US
Practice Address - Phone:402-721-6333
Practice Address - Fax:402-721-6320
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB67846Medicare UPIN
NE095365Medicare ID - Type Unspecified