Provider Demographics
NPI:1568489375
Name:STUBBS, RACHAEL (MD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:STUBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2981 E JULIET WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7023
Mailing Address - Country:US
Mailing Address - Phone:801-860-2190
Mailing Address - Fax:801-733-4866
Practice Address - Street 1:2981 JULIET WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-7023
Practice Address - Country:US
Practice Address - Phone:801-860-2190
Practice Address - Fax:801-733-4866
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT183426-1205207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000011990Medicare ID - Type Unspecified
UTF41986Medicare UPIN