Provider Demographics
NPI:1013924687
Name:DEFREECE, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:DEFREECE
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 1:2000 Q ST
Mailing Address - Street 2:STE 500
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3610
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:1700 14TH AVE
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-1146
Practice Address - Country:US
Practice Address - Phone:402-873-4242
Practice Address - Fax:402-873-4227
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3935866Medicaid
NE01-06554OtherUHC
NE00812OtherBCBS
NE4998OtherMIDLAND'S CHOICE
NE10025323000Medicaid
NE100254400 00Medicaid
NE28-3859Medicare PIN
NE00812OtherBCBS
NE4998OtherMIDLAND'S CHOICE
NEP00282540Medicare PIN