Provider Demographics
NPI:1548606080
Name:STUBBS, BROOKE VEITH (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:VEITH
Last Name:STUBBS
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 MEDICAL PKWY STE 216
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3729
Mailing Address - Country:US
Mailing Address - Phone:512-920-2414
Mailing Address - Fax:
Practice Address - Street 1:4107 MEDICAL PKWY STE 216
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3729
Practice Address - Country:US
Practice Address - Phone:512-920-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR3762207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program