Healthcare Provider Details

I. General information

NPI: 1609969476
Provider Name (Legal Business Name): DAVID MWEBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E WAYNE ST
RANDOLPH NE
68771-5300
US

IV. Provider business mailing address

PO BOX 429
OSMOND NE
68765-0429
US

V. Phone/Fax

Practice location:
  • Phone: 402-337-0200
  • Fax: 402-337-1020
Mailing address:
  • Phone: 402-748-3393
  • Fax: 402-748-6190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23791
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: