Provider Demographics
NPI:1578577656
Name:WESTBERG, DUANE ERIC (MD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:ERIC
Last Name:WESTBERG
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 1:10 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1820
Mailing Address - Country:US
Mailing Address - Phone:320-634-4521
Mailing Address - Fax:320-634-2262
Practice Address - Street 1:10 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1820
Practice Address - Country:US
Practice Address - Phone:320-634-4521
Practice Address - Fax:320-634-2262
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
129792OtherUCARE
1340923OtherARAZ
39-01330OtherMEDICA
01-07474OtherMEDICA
MN45G78WEOtherBLUE CROSS
HP30226OtherHEALTH PARTNERS
MEDICAOther01-07473
NA9331022748OtherPREFERRED ONE
01-07476OtherMEDICA
129792OtherUCARE