Individual
GREGORY A JEPPESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
800 MERCY DR, COUNCIL BLUFFS, IA 51503-3128
(712) 328-5230
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4231
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
34008307
OH
207P00000X
Emergency Medicine Physician
Primary
4162
IA
207P00000X
Emergency Medicine Physician
793
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000479752
BCBS
—
05
—
114915360
—
MI
05
—
2672853
—
OH
01
—
P00326862
RAILROAD MEDICARE
OH
Enumeration date
06/20/2006
Last updated
06/19/2013
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