Provider Demographics
NPI:1437226826
Name:BOLLINGER, DWIGHT JAMES (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:JAMES
Last Name:BOLLINGER
Suffix:
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 1:10251 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-4523
Mailing Address - Country:US
Mailing Address - Phone:402-593-0364
Mailing Address - Fax:
Practice Address - Street 1:4840 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-1407
Practice Address - Country:US
Practice Address - Phone:402-731-4145
Practice Address - Fax:402-731-8653
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17841207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE90300BOMedicare ID - Type Unspecified
NEE37933Medicare UPIN