Provider Demographics
NPI:1891765004
Name:HUTFLESS, GEORGE STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:STANLEY
Last Name:HUTFLESS
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 1:3440 S 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3829
Mailing Address - Country:US
Mailing Address - Phone:402-556-3000
Mailing Address - Fax:402-991-7115
Practice Address - Street 1:3440 S 50TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3829
Practice Address - Country:US
Practice Address - Phone:402-556-3000
Practice Address - Fax:402-991-7115
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00373OtherBLUE CROSS BLUE SHIELD
NE47084517200Medicaid
NE04-00021OtherUNITED HEALTHCARE
NE18358Medicaid
NE18358OtherNEBRASKA STATE LICENSE #
NE11602OtherMIDLANDS CHOICE PROVIDER
IA2965301Medicaid
IA2965301Medicaid
NE04-00021OtherUNITED HEALTHCARE
NE099192Medicare ID - Type UnspecifiedMEDICARE GROUP #
NE04-00021Medicare ID - Type UnspecifiedMEDICARE COMPLETE
IA2965301Medicaid
NE47084517200Medicaid