Provider Demographics
NPI:1811071442
Name:FATTIG, WILLIAM VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VICTOR
Last Name:FATTIG
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 1:723 FLACK AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3514
Mailing Address - Country:US
Mailing Address - Phone:308-225-4498
Mailing Address - Fax:308-629-1499
Practice Address - Street 1:723 FLACK AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3514
Practice Address - Country:US
Practice Address - Phone:308-225-4498
Practice Address - Fax:308-629-1499
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200269730AOtherKANSAS MEDICAID
NE28D1030805OtherCLIA
NE35808OtherMIDLANDS
NEP00181202OtherRR MEDICARE
NE35808OtherMIDLANDS
NE35808OtherMIDLANDS
NEP00181202OtherRR MEDICARE