Provider Demographics
NPI:1194112581
Name:BERG, JEREMY DEAN (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:DEAN
Last Name:BERG
Suffix:
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 1:4840 F ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-1407
Mailing Address - Country:US
Mailing Address - Phone:402-731-4145
Mailing Address - Fax:402-731-8653
Practice Address - Street 1:4840 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-1407
Practice Address - Country:US
Practice Address - Phone:402-731-4145
Practice Address - Fax:402-731-8653
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.136417207ZP0102X
SD221390200000X
NE32760207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program