Healthcare Provider Details

I. General information

NPI: 1336342476
Provider Name (Legal Business Name): DWIGHT FRANKLIN RICKARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 W VAN DORN ST
LINCOLN NE
68522-9278
US

IV. Provider business mailing address

1604 S 189TH CT
OMAHA NE
68130-2845
US

V. Phone/Fax

Practice location:
  • Phone: 402-479-6330
  • Fax: 402-479-6168
Mailing address:
  • Phone: 402-330-0259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number10982
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: