Basic Information
| Provider Information | |||||||||
| NPI: | 1821000233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WURTZ | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8055 O ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685102580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024210896 | ||||||||
| FaxNumber: | 4024210945 | ||||||||
| Practice Location | |||||||||
| Address1: | 7121 STEPHANIE LN | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685165359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024848383 | ||||||||
| FaxNumber: | 4024847043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 07/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21716 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01-01733 | 01 | NE | UHC | OTHER | 470780857 11 | 05 | NE | MEDICAID | 230754 | 01 | NE | MIDLAND'S CHOICE | OTHER | 31499 | 01 | NE | BCBS | OTHER |