Provider Demographics
NPI:1154345973
Name:MATZKE, GERALD E JR (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:E
Last Name:MATZKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138
Mailing Address - Country:US
Mailing Address - Phone:308-537-2174
Mailing Address - Fax:
Practice Address - Street 1:918 20TH STREET
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-1237
Practice Address - Country:US
Practice Address - Phone:308-537-7131
Practice Address - Fax:308-537-7310
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0436174207P00000X
NE16542207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07025OtherBC/BS
NE10026082600Medicaid
E60084Medicare UPIN
NE10026082600Medicaid
280395Medicare PIN
NEE60084Medicare UPIN