Individual
MATTHEW M JAKSHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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