Provider Demographics
NPI:1790867893
Name:SIKES, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:SIKES
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 1:4239 FARNAM ST
Mailing Address - Street 2:#502
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2868
Mailing Address - Country:US
Mailing Address - Phone:402-552-2886
Mailing Address - Fax:402-552-2888
Practice Address - Street 1:4239 FARNAM ST
Practice Address - Street 2:#502
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2868
Practice Address - Country:US
Practice Address - Phone:402-552-2886
Practice Address - Fax:402-552-2888
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE16965207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025014200Medicaid
NE01595OtherBCBS
IA5984500Medicaid
NE276948Medicare ID - Type Unspecified
IA5984500Medicaid