Provider Demographics
NPI:1245762673
Name:KUBOVEC, STACEY AMBER (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:AMBER
Last Name:KUBOVEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-634-7500
Mailing Address - Fax:918-634-7560
Practice Address - Street 1:1919 S WHEELING AVE STE 600
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5635
Practice Address - Country:US
Practice Address - Phone:918-634-7500
Practice Address - Fax:918-634-7560
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK42481208600000X
IN01088159A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery