Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 15157 | NE |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 31601 | IA |
NPI | 1003895178 |
---|---|
Provider Name | Mr. Stuart Gordon Oxford |
First Address | Omaha, NE 68134-0597 |
Second Address | Omaha, NE 68114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 17/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0905802 | (05) | IA |
250000014 | PALMETTO GBA - RRMC (01) | |
47062885200 | (05) | NE |
B90805 | (02) |