Provider Demographics
NPI:1003895178
Name:OXFORD, STUART GORDON (MD)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:GORDON
Last Name:OXFORD
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:PO BOX 34597
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0597
Mailing Address - Country:US
Mailing Address - Phone:402-397-8891
Mailing Address - Fax:402-397-8892
Practice Address - Street 1:8309 CASS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-397-8891
Practice Address - Fax:402-397-8892
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15157208100000X
IA31601208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
250000014OtherPALMETTO GBA - RRMC
IA0905802Medicaid
NE47062885200Medicaid
B90805Medicare UPIN
250000014OtherPALMETTO GBA - RRMC
NE095118Medicare ID - Type Unspecified
IA42128Medicare ID - Type Unspecified