Provider Demographics
NPI:1275544033
Name:WILSON, BERNARD J JR (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:555 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2462
Practice Address - Country:US
Practice Address - Phone:402-219-7420
Practice Address - Fax:402-219-7651
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE191852080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE236610OtherMIDLAND'S CHOICE
IA0586131Medicaid
KS2087727301Medicaid
NE00294OtherBCBS
NE470780857 02Medicaid
47-00060OtherUHC
47-00060OtherUHC
KS2087727301Medicaid