Healthcare Provider Details

I. General information

NPI: 1336900349
Provider Name (Legal Business Name): KEIRON SAUER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 W FAIDLEY AVE
GRAND ISLAND NE
68803-4205
US

IV. Provider business mailing address

10656 HAMILTON PLZ APT 510
OMAHA NE
68114-2044
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-4600
  • Fax:
Mailing address:
  • Phone: 651-767-2809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1209018
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: