Provider Demographics
NPI:1336342476
Name:RICKARD, DWIGHT FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:FRANKLIN
Last Name:RICKARD
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 1:1604 S 189TH CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2845
Mailing Address - Country:US
Mailing Address - Phone:402-330-0259
Mailing Address - Fax:
Practice Address - Street 1:3220 W VAN DORN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-9278
Practice Address - Country:US
Practice Address - Phone:402-479-6330
Practice Address - Fax:402-479-6168
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10982207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEAR-710-9045OtherDEA
NEA-33584Medicare UPIN