Provider Demographics
NPI:1003815101
Name:WESTBURG, STUART PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:PAUL
Last Name:WESTBURG
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 1:2756 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1341
Mailing Address - Country:US
Mailing Address - Phone:402-474-4497
Mailing Address - Fax:
Practice Address - Street 1:2756 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1341
Practice Address - Country:US
Practice Address - Phone:402-474-4497
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12613207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03075OtherBC/BS PROVIDER #
NE47067550600Medicaid
NE03075OtherBC/BS PROVIDER #
NE47067550600Medicaid