Provider Demographics
NPI:1831294099
Name:GILL, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:GILL
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 1:2115 14TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-1760
Mailing Address - Country:US
Mailing Address - Phone:402-274-4993
Mailing Address - Fax:402-274-4905
Practice Address - Street 1:2115 14TH ST STE 100
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-1760
Practice Address - Country:US
Practice Address - Phone:402-274-4993
Practice Address - Fax:402-274-4905
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075088600Medicaid
NE274178Medicare ID - Type Unspecified
H05305Medicare UPIN