Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 12613 | NE |
NPI | 1003815101 |
---|---|
Provider Name | Dr. Stuart Paul Westburg |
First Address | Lincoln, NE 68510-1341 |
Second Address | Lincoln, NE 68510-1341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03075 | BC/BS PROVIDER # (01) | NE |
47067550600 | (05) | NE |
B67611 | (02) | NE |