=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144541335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM C DORWART M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2010
-----------------------------------------------------
Last Update Date | 01/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6829 N 72ND ST SUITE 3100
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68122-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-572-3900
-----------------------------------------------------
Fax | 402-572-3238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6829 N 72ND ST SUITE 3100
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68122-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-257-2390
-----------------------------------------------------
Fax | 402-572-3238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 26891
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 39715
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------