Provider Demographics
NPI:1922116144
Name:HOLLISTER, JEFF E (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:E
Last Name:HOLLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:621 W FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-0608
Mailing Address - Country:US
Mailing Address - Phone:308-534-8800
Mailing Address - Fax:608-534-5469
Practice Address - Street 1:621 W FRANCIS ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0608
Practice Address - Country:US
Practice Address - Phone:308-534-8800
Practice Address - Fax:608-534-5469
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007021130207L00000X, 207L00000X
ARE-6316207L00000X
NE24135207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204465702Medicaid
NE100255862-00Medicaid
MO312345236Medicare PIN
NE100255862-00Medicaid
MD195573ZEGJMedicare PIN
MO312340635Medicare PIN