Individual
WILLIAM P FITZGIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1908 N 203RD ST, ELKHORN, NE 68022-2889
(402) 289-4031
(402) 289-3185
Mailing address
1908 N 203RD ST STE 2, ELKHORN, NE 68022-2889
(402) 289-4031
(402) 289-3185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15830
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0903302
MEDIPASS
—
01
—
1265405617
NPI
—
01
—
15830
LICENSE
NE
01
—
470710146
TAX I D
—
05
—
470710146-13
—
NE
Enumeration date
02/08/2006
Last updated
03/07/2023
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