Healthcare Provider Details

I. General information

NPI: 1447355623
Provider Name (Legal Business Name): GARY R ENSZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 14TH ST SUITE 100
AUBURN NE
68305-1797
US

IV. Provider business mailing address

2115 14TH ST SUITE 100
AUBURN NE
68305-1797
US

V. Phone/Fax

Practice location:
  • Phone: 402-274-4993
  • Fax: 402-274-4905
Mailing address:
  • Phone: 402-274-4993
  • Fax: 402-274-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14016
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: