Provider Demographics
NPI:1023099678
Name:VONDERFECHT, SCOTT L (MD)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:L
Last Name:VONDERFECHT
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 1:309 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-4225
Mailing Address - Country:US
Mailing Address - Phone:402-745-6279
Mailing Address - Fax:402-991-9052
Practice Address - Street 1:309 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467
Practice Address - Country:US
Practice Address - Phone:402-745-6279
Practice Address - Fax:402-991-9052
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE265357Medicare ID - Type Unspecified
NEF95291Medicare UPIN