Provider Demographics
NPI:1952372187
Name:DYNEK, JEFFREY A (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:DYNEK
Suffix:
Gender:M
Credentials:PA
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 STREET
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3610
Mailing Address - Country:US
Mailing Address - Phone:402-328-4922
Mailing Address - Fax:402-421-0946
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-489-6555
Practice Address - Fax:402-328-3770
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1353363AM0700X
NE1341363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026072500Medicaid
NE10026072600Medicaid
OKP00128663OtherMEDICARE RAILROAD
OK200022270AMedicaid
NE281672Medicare PIN
NE10026072600Medicaid
NENA1080028Medicare PIN
NENA1079038Medicare PIN
NENA1939017Medicare PIN
OKP00128663OtherMEDICARE RAILROAD
OK241411709Medicare ID - Type Unspecified