Provider Demographics
NPI:1588680953
Name:WETOVICK, PATRICK G (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:G
Last Name:WETOVICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1803 PAPIO LANE
Mailing Address - Street 2:PO BOX 86
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-0086
Mailing Address - Country:US
Mailing Address - Phone:308-784-3535
Mailing Address - Fax:308-784-3534
Practice Address - Street 1:1803 PAPIO LN
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130-1138
Practice Address - Country:US
Practice Address - Phone:308-784-3535
Practice Address - Fax:308-784-3534
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2014-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NENE20843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE080165449Medicaid
NE272965Medicare ID - Type Unspecified
NE080165449Medicaid