Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 35764 | IA |
NPI | 1700820586 |
---|---|
Provider Name | Dr. Dean Kelvin Wampler |
First Address | Omaha, NE 68127-1639 |
Second Address | Omaha, NE 68127-1639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/07/2007 |