Individual
MATTHEW M JAKSHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7500 MERCY RD, ALEGENT BERGAN MERCY DEPT OF RADIOLOGY, OMAHA, NE 68124-2319
(402) 398-5890
Mailing address
PO BOX 4460, OMAHA, NE 68104
(866) 491-5807
(913) 491-0411
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
21482
NE
2085R0202X
Diagnostic Radiology Physician
33654
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0223388
—
IA
01
—
03518
BCBS
NE
05
—
0571877
—
IA
05
—
1223388
—
IA
05
—
1571877
—
IA
01
—
20829
MIDLANDS
—
01
—
21482
NE LICENSE #
NE
01
—
22367
BCBS
IA
01
—
33654
IA LICENSE #
—
05
—
4223388
—
IA
01
—
BJ6988907
IA CONTROLLED SUBSTANCE
—
Enumeration date
06/20/2006
Last updated
03/07/2023
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