Individual
ERIC A VANDER WOUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7601 PIONEERS BLVD, LINCOLN, NE 68506
(402) 484-6677
(402) 484-4476
Mailing address
7601 PIONEERS BLVD, LINCOLN, NE 68506-4675
(402) 484-6677
(402) 484-4476
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
23267
NE
2085R0204X
Vascular & Interventional Radiology Physician
Primary
23267
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00892
BCBS
NE
01
—
098991002
AMI MEDICARE PIN
NE
05
—
47078180813
—
NE
Enumeration date
04/19/2007
Last updated
04/23/2018
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