Provider Demographics
NPI:1194894451
Name:VAN ERT, GARY P (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:VAN ERT
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 1:4701 NORMAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5563
Mailing Address - Country:US
Mailing Address - Phone:402-484-5656
Mailing Address - Fax:402-484-5741
Practice Address - Street 1:4701 NORMAL BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5563
Practice Address - Country:US
Practice Address - Phone:402-484-5656
Practice Address - Fax:402-484-5741
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2553207Q00000X
NE26716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDAH9141044828OtherPREFERRED ONE
SD0120251OtherMEDICA
SD5602532Medicaid
SD4995081OtherBCBS
SD4995081OtherBCBS
SD0120251OtherMEDICA
SDDD0306Medicare PIN