Provider Demographics
NPI:1275723322
Name:STUART P. WESTBURG, MD
Entity Type:Organization
Organization Name:STUART P. WESTBURG, MD
Other - Org Name:LINCOLN DERMATOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:P
Authorized Official - Last Name:WESTBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-474-4497
Mailing Address - Street 1:PO BOX 2140
Mailing Address - Street 2:LOCK BOX 408
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2140
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12613207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB67611Medicare UPIN