Provider Demographics
NPI:1043325228
Name:LIONBERGER, JACK M (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:M
Last Name:LIONBERGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10010 KENNERLY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2106
Mailing Address - Country:US
Mailing Address - Phone:314-525-1328
Mailing Address - Fax:314-525-1378
Practice Address - Street 1:2300 S 16TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3704
Practice Address - Country:US
Practice Address - Phone:402-475-1011
Practice Address - Fax:402-481-4783
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE31350207RX0202X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology