Healthcare Provider Details

I. General information

NPI: 1215084199
Provider Name (Legal Business Name): JONATHAN E. BUZZELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 S 144TH ST STE 212
OMAHA NE
68144-5253
US

IV. Provider business mailing address

2725 S 144TH ST STE 212
OMAHA NE
68144-5253
US

V. Phone/Fax

Practice location:
  • Phone: 402-637-0800
  • Fax: 402-637-0808
Mailing address:
  • Phone: 402-637-0800
  • Fax: 402-637-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25040
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: