Provider Demographics
NPI:1578546644
Name:STRUBLE, STEPHEN GRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GRAHAM
Last Name:STRUBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:115 PARKWAY OFFICE CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7423
Mailing Address - Country:US
Mailing Address - Phone:919-277-0427
Mailing Address - Fax:919-233-4492
Practice Address - Street 1:115 PARKWAY OFFICE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7423
Practice Address - Country:US
Practice Address - Phone:919-277-0427
Practice Address - Fax:919-233-4492
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240060207X00000X
NC200500675207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901028Medicaid
SCN0067CMedicaid
SCN0067CMedicaid
NC2041702Medicare ID - Type Unspecified