Healthcare Provider Details

I. General information

NPI: 1467446799
Provider Name (Legal Business Name): WALLACE E DUFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11704 W CENTER RD STE 210
OMAHA NE
68144-4327
US

IV. Provider business mailing address

11704 W CENTER RD STE 210
OMAHA NE
68144-4327
US

V. Phone/Fax

Practice location:
  • Phone: 402-393-1454
  • Fax:
Mailing address:
  • Phone: 402-393-1454
  • Fax: 402-393-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number11860
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11860
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: