Provider Demographics
NPI:1396755989
Name:WOLCOTT, GEORGE J (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:WOLCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6937
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0937
Mailing Address - Country:US
Mailing Address - Phone:402-476-2021
Mailing Address - Fax:402-476-2008
Practice Address - Street 1:1021 N 27TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-1803
Practice Address - Country:US
Practice Address - Phone:402-476-1455
Practice Address - Fax:402-476-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21-21961742084N0400X
NE126052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1542OtherBCBS
NE47-055858300Medicaid
NE0500051OtherUHC
NE131121787OtherRR MEDICARE
NE4257OtherMIDLANDS
NE47-055858300Medicaid
NE4257OtherMIDLANDS