Healthcare Provider Details

I. General information

NPI: 1811980261
Provider Name (Legal Business Name): WAYNE K SUMPTER MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD
OFFUTT AFB NE
68113-1043
US

IV. Provider business mailing address

2501 CAPEHART RD
OFFUTT AFB NE
68113-1043
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-7346
  • Fax: 402-294-9138
Mailing address:
  • Phone: 402-294-7346
  • Fax: 402-294-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24255
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberG67924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: