Provider Demographics
NPI:1396960811
Name:SEILER, JERRY K (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:K
Last Name:SEILER
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 1:620 N DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5122
Mailing Address - Country:US
Mailing Address - Phone:402-463-1355
Mailing Address - Fax:402-463-6947
Practice Address - Street 1:620 N DENVER AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5122
Practice Address - Country:US
Practice Address - Phone:402-463-1355
Practice Address - Fax:402-463-6947
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063875100Medicaid
NE47063875100Medicaid
NEB67975Medicare UPIN