Provider Demographics
NPI:1538258041
Name:NEUBAUER, JO MARIE (MD)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:MARIE
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3516
Mailing Address - Country:US
Mailing Address - Phone:605-665-1855
Mailing Address - Fax:605-664-0620
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101
Practice Address - Country:US
Practice Address - Phone:712-279-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25968207P00000X
SD1233207P00000X
NE17716207P00000X
ND6429207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0067108Medicaid
IA241786OtherBLUE CROSS
IA0067108Medicaid
IA01538Medicare ID - Type Unspecified