Provider Demographics
NPI:1841228798
Name:DAVIS, JASON J (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 S 70TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4282
Mailing Address - Country:US
Mailing Address - Phone:402-489-3834
Mailing Address - Fax:402-489-5049
Practice Address - Street 1:4501 S 70TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4282
Practice Address - Country:US
Practice Address - Phone:402-489-3834
Practice Address - Fax:402-489-5049
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE22519208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47049487112Medicaid
NE12 01036OtherUNITED HEALTHCARE
NE238921OtherMIDLANDS CHOICE
NE31574OtherBLUE CROSS BLUE SHIELD
NEH87625Medicare UPIN
NE31574OtherBLUE CROSS BLUE SHIELD