Provider Demographics
NPI:1417947672
Name:STUBBLEFIELD, WILLIAM SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SCOTT
Last Name:STUBBLEFIELD
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:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:BROOKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72417
Mailing Address - Country:US
Mailing Address - Phone:870-932-1211
Mailing Address - Fax:870-932-5849
Practice Address - Street 1:102 WEST SMITH
Practice Address - Street 2:
Practice Address - City:BROOKLAND
Practice Address - State:AR
Practice Address - Zip Code:72417
Practice Address - Country:US
Practice Address - Phone:870-932-1211
Practice Address - Fax:870-932-5849
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR53461Medicare PIN
ARE32982Medicare UPIN