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Individual

DAVID BRIAN WILTFONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5500 PINE LAKE RD, LINCOLN, NE 68516-3389
(402) 489-8888
(402) 421-1945
Mailing address
5500 PINE LAKE RD, LINCOLN, NE 68516-3389
(402) 489-8888
(402) 421-1945

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
20738
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01240
BLUE CROSS BLUE SHIELD
05
0230045
IA
05
100406410A
KS
01
1900097
UNITED HEALTH CARE
05
200396660A
IN
01
340015315
RR MEDICARE
01
7582
MIDLANDS CHOICE
Enumeration date
07/26/2006
Last updated
01/06/2022
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