Provider Demographics
NPI:1952444788
Name:NELSON, JEFFREY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:NELSON
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 1:16945 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2312
Mailing Address - Country:US
Mailing Address - Phone:402-397-7400
Mailing Address - Fax:402-397-0115
Practice Address - Street 1:16945 FRANCES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2312
Practice Address - Country:US
Practice Address - Phone:402-397-7400
Practice Address - Fax:402-397-0115
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19195207K00000X, 207KA0200X, 2080P0201X, 2080P0214X
IA27873207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Not Answered2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Not Answered2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0200028OtherNE UNITED HEALTHCARE
NE765OtherMIDLANDS CHOICE #
IA0908400Medicaid
NE06148OtherNE BCBSN #
NE06148OtherNE BCBSN #
NE0200028OtherNE UNITED HEALTHCARE