Provider Demographics
NPI:1699775155
Name:LIAS, JEFFREY DEAN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DEAN
Last Name:LIAS
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 1:709 W 4TH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2270
Mailing Address - Country:US
Mailing Address - Phone:308-747-2135
Mailing Address - Fax:
Practice Address - Street 1:266 CHADRON AVE
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2348
Practice Address - Country:US
Practice Address - Phone:308-747-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19787208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7775975Medicaid
13912OtherMIDLANDS CHOICE
NE00859OtherBLUE CROSS BLUE SHIELD
NE47054313213Medicaid
SD7775974Medicaid
NE276130Medicare ID - Type UnspecifiedINDIV MEDICARE NUMB
NE47054313213Medicaid
020054501Medicare ID - Type UnspecifiedRAILROAD MEDICARE