Healthcare Provider Details

I. General information

NPI: 1275723322
Provider Name (Legal Business Name): STUART P. WESTBURG, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2756 O ST
LINCOLN NE
68510-1341
US

IV. Provider business mailing address

PO BOX 2140 LOCK BOX 408
OMAHA NE
68103-2140
US

V. Phone/Fax

Practice location:
  • Phone: 402-474-4497
  • Fax:
Mailing address:
  • Phone: 402-474-4497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number12613
License Number StateNE

VIII. Authorized Official

Name: STUART P WESTBURG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-474-4497