Provider Demographics
NPI:1235446303
Name:STUBBS, ERVIN GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:GENE
Last Name:STUBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERVIN
Other - Middle Name:GENE
Other - Last Name:STUBBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PC
Mailing Address - Street 1:7032 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2214
Mailing Address - Country:US
Mailing Address - Phone:503-939-7351
Mailing Address - Fax:503-722-4450
Practice Address - Street 1:7032 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2214
Practice Address - Country:US
Practice Address - Phone:503-939-7351
Practice Address - Fax:503-722-4450
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR77452084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry