Provider Demographics
NPI:1134175821
Name:WIRTH, DONALD G (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
Last Name:WIRTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2116 W FAIDLEY AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4671
Mailing Address - Country:US
Mailing Address - Phone:308-381-0162
Mailing Address - Fax:308-389-4445
Practice Address - Street 1:2116 W FAIDLEY AVE
Practice Address - Street 2:STE 400
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4671
Practice Address - Country:US
Practice Address - Phone:308-381-0162
Practice Address - Fax:308-389-4445
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NE17002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEAW2110598OtherDEA
NEAW2110598OtherDEA
NEA02567Medicare UPIN