Healthcare Provider Details

I. General information

NPI: 1972593374
Provider Name (Legal Business Name): ALAN WAYNE LANGVARDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W COURT ST
BEATRICE NE
68310-3525
US

IV. Provider business mailing address

805 W COURT ST PO BOX 578
BEATRICE NE
68310-3525
US

V. Phone/Fax

Practice location:
  • Phone: 402-228-3366
  • Fax: 402-228-3502
Mailing address:
  • Phone: 402-228-3366
  • Fax: 402-228-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12760
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: