Provider Demographics
NPI:1386872372
Name:PUETZ, JILL FRANCES (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:FRANCES
Last Name:PUETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:FRANCES
Other - Last Name:MAYHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:402-829-8513
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:ATTN: HOSPITAL MEDICINE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2319
Practice Address - Country:US
Practice Address - Phone:402-398-5580
Practice Address - Fax:402-398-5589
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26758208M00000X, 207R00000X
IA40425207R00000X
IAMD-40425208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098611083OtherMEDICARE PTAN
IAI87040069OtherMEDICARE PTAN