Provider Demographics
NPI:1679576722
Name:WIEBE, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WIEBE
Suffix:
Gender:M
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:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-2168
Mailing Address - Country:US
Mailing Address - Phone:308-865-2512
Mailing Address - Fax:308-865-2506
Practice Address - Street 1:3500 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2944
Practice Address - Country:US
Practice Address - Phone:308-865-2512
Practice Address - Fax:308-865-2506
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12637207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS46969OtherBCBS
NE1553OtherBCBS
KS645540OtherFIRSTGUARD
NE1553OtherBCBS
KS645540OtherFIRSTGUARD
KS46969OtherBCBS