Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 10982 | NE |
NPI | 1336342476 |
---|---|
Provider Name | Dr. Dwight Franklin Rickard |
First Address | Omaha, NE 68130-2845 |
Second Address | Lincoln, NE 68522-9278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A-33584 | (02) | NE |
AR-710-9045 | DEA (01) | NE |