Healthcare Provider Details

I. General information

NPI: 1003221029
Provider Name (Legal Business Name): GABRIEL JEFFERSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2014
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 N 26TH ST SUITE 100
LINCOLN NE
68521-4749
US

IV. Provider business mailing address

2222 S 16TH ST STE 400A
LINCOLN NE
68502-3785
US

V. Phone/Fax

Practice location:
  • Phone: 402-435-5300
  • Fax:
Mailing address:
  • Phone: 402-483-8590
  • Fax: 402-483-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: