Provider Demographics
NPI:1063487379
Name:HEAD, GEORGE GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:GILBERT
Last Name:HEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G
Other - Middle Name:GILBERT
Other - Last Name:HEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17241 OAK DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2202
Mailing Address - Country:US
Mailing Address - Phone:402-896-1242
Mailing Address - Fax:402-896-8948
Practice Address - Street 1:17241 OAK DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2202
Practice Address - Country:US
Practice Address - Phone:402-896-1242
Practice Address - Fax:402-896-8948
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073659713Medicaid
NE095541Medicare ID - Type Unspecified
NE47073659713Medicaid