MEDICARE: JONATHAN WEITZMANN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	23007	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00192908	OTHER	NE	RR
2	06222	OTHER	NE	BCBSNE

General Provider Information

NPI Number	:	1548201643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN WEITZMANN M.D.

Provider Business Mailing Address
First Line	:	110 N 29TH ST
Second Line	:	STE. 201
City	:	NORFOLK
State	:	NE
Zip	:	68701-4424
Country	:	US
Telephone Number	:	402-844-8121
Fax Number	:	402-844-8122

Provider Business Practice Location Address
First Line	:	110 N 29TH ST
Second Line	:	STE. 303
City	:	NORFOLK
State	:	NE
Zip	:	68701-4461
Country	:	US
Telephone Number	:	402-844-8131
Fax Number	:	402-844-8130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	04/09/2008

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