Healthcare Provider Details

I. General information

NPI: 1699775155
Provider Name (Legal Business Name): JEFFREY DEAN LIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 CHADRON AVE
CHADRON NE
69337-2348
US

IV. Provider business mailing address

709 W 4TH ST STE 2
CHADRON NE
69337-2270
US

V. Phone/Fax

Practice location:
  • Phone: 308-747-2135
  • Fax:
Mailing address:
  • Phone: 308-747-2135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19787
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: