Healthcare Provider Details

I. General information

NPI: 1154345973
Provider Name (Legal Business Name): GERALD E MATZKE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 20TH STREET
GOTHENBURG NE
69138-1237
US

IV. Provider business mailing address

918 20TH STREET
GOTHENBURG NE
69138
US

V. Phone/Fax

Practice location:
  • Phone: 308-537-7131
  • Fax: 308-537-7310
Mailing address:
  • Phone: 308-537-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0436174
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number16542
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: