Healthcare Provider Details

I. General information

NPI: 1639177009
Provider Name (Legal Business Name): STEPHEN J DREYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 N CLARKSON ST
FREMONT NE
68025-7718
US

IV. Provider business mailing address

2830 N CLARKSON ST
FREMONT NE
68025-7718
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-6333
  • Fax: 402-721-6320
Mailing address:
  • Phone: 402-721-6333
  • Fax: 402-721-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12303
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: