Provider Demographics
NPI:1881784973
Name:PAPENFUSS, JASON STEWART (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:STEWART
Last Name:PAPENFUSS
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 1:4242 FARNAM ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2806
Mailing Address - Country:US
Mailing Address - Phone:402-552-2555
Mailing Address - Fax:
Practice Address - Street 1:4242 FARNAM ST
Practice Address - Street 2:SUITE 360
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2806
Practice Address - Country:US
Practice Address - Phone:402-552-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22840207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA99480OtherWELLMARK BLUE CROSS BLUE
IA0749804Medicaid
253353OtherMIDLEANDS CHOICE
253353OtherMIDLEANDS CHOICE