Individual
SCOTT P. WATTENHOFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
515 N 162ND AVE, SUITE 300, OMAHA, NE 68118-2539
(402) 393-6624
(402) 393-6635
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
18497
NE
2086S0129X
Vascular Surgery Physician
31435
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025724800
—
NE
05
—
10026135000
—
NE
05
—
10026135100
—
NE
05
—
1215911813
—
IA
Enumeration date
12/06/2005
Last updated
08/06/2014
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