Provider Demographics
NPI:1477130482
Name:STUBBLEFIELD, SETH KYLAR (DO)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:KYLAR
Last Name:STUBBLEFIELD
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 1:4341 W VILLA THERESA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1627
Mailing Address - Country:US
Mailing Address - Phone:469-261-2468
Mailing Address - Fax:
Practice Address - Street 1:4341 W VILLA THERESA DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1627
Practice Address - Country:US
Practice Address - Phone:469-261-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program