Healthcare Provider Details

I. General information

NPI: 1972241701
Provider Name (Legal Business Name): JEREMY KARL STONE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981045 NEBRASKA MEDICAL CTR
OMAHA NE
68198-1406
US

IV. Provider business mailing address

2302 CLAY ST
BELLEVUE NE
68005-3931
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number9527
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: