Provider Demographics
NPI:1629070347
Name:WENDT, JAMES C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:WENDT
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 1:620 N ALPHA ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4316
Mailing Address - Country:US
Mailing Address - Phone:308-381-0473
Mailing Address - Fax:308-381-2616
Practice Address - Street 1:620 N ALPHA ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4316
Practice Address - Country:US
Practice Address - Phone:308-381-0473
Practice Address - Fax:308-381-2616
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15992208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE340004907OtherRAILROAD MEDICARE
NE47070756913Medicaid
NE1223OtherBCBS
NE1223OtherBCBS
NE47070756913Medicaid