Basic Information
| Provider Information | |||||||||
| NPI: | 1649227935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AILES | ||||||||
| FirstName: | JEFFRY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7601 PIONEERS BLVD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024846677 | ||||||||
| FaxNumber: | 4024844476 | ||||||||
| Practice Location | |||||||||
| Address1: | 7601 PIONEERS BLVD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024846677 | ||||||||
| FaxNumber: | 4024844476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 06/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 23197 | NE | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 47078180813 | 05 | NE | MEDICAID | 00291 | 01 | NE | BCBS | OTHER | 200316300A | 05 | KS | MEDICAID |