Provider Demographics
NPI:1043419690
Name:SUBER, STEPHANIE A (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SUBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4930 OVERLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-856-0708
Mailing Address - Fax:785-856-0709
Practice Address - Street 1:4930 OVERLAND DRIVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-856-0708
Practice Address - Fax:785-856-0709
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-32796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine