Provider Demographics
NPI:1053300152
Name:STUBBERS, JOSEPH JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:STUBBERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 MACK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5161
Mailing Address - Country:US
Mailing Address - Phone:513-860-3016
Mailing Address - Fax:513-860-3073
Practice Address - Street 1:2740 MACK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5161
Practice Address - Country:US
Practice Address - Phone:513-860-3016
Practice Address - Fax:513-860-3073
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000015712OtherBCBS
OH110084589OtherMEDICARE RAILROAD
OHST0714904Medicare PIN
OH110084589OtherMEDICARE RAILROAD