Provider Demographics
NPI:1760680011
Name:LADD, JEREMIAH P (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:P
Last Name:LADD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13616 CALIFORNIA ST
Mailing Address - Street 2:SUITE #100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5335
Mailing Address - Country:US
Mailing Address - Phone:402-496-0404
Mailing Address - Fax:402-496-7766
Practice Address - Street 1:13616 CALIFORNIA ST
Practice Address - Street 2:SUITE #100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5335
Practice Address - Country:US
Practice Address - Phone:402-496-0404
Practice Address - Fax:402-496-7766
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2012-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE26816208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026241700Medicaid
NE10026241700Medicaid