Healthcare Provider Details

I. General information

NPI: 1700828415
Provider Name (Legal Business Name): SIDNEY W JAEGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 BUFFALO BND
LEXINGTON NE
68850-1528
US

IV. Provider business mailing address

1103 BUFFALO BND PO BOX 797
LEXINGTON NE
68850-1528
US

V. Phone/Fax

Practice location:
  • Phone: 308-324-6386
  • Fax: 308-324-6913
Mailing address:
  • Phone: 308-324-6386
  • Fax: 308-324-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5000
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: