Provider Demographics
NPI:1073588620
Name:KOUBA, STEPHEN HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HOWARD
Last Name:KOUBA
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 1:1219 WALTER REED RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4437
Mailing Address - Country:US
Mailing Address - Phone:910-609-5000
Mailing Address - Fax:910-615-9600
Practice Address - Street 1:1219 WALTER REED RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4437
Practice Address - Country:US
Practice Address - Phone:910-609-5000
Practice Address - Fax:910-615-9600
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29766207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950238Medicaid
NC50238OtherBCBS INDIVIDUAL ID NUMBER
NC8950238Medicaid
NC207970Medicare ID - Type UnspecifiedINDIVIDUAL ID NUMBER