Provider Demographics
NPI:1619112596
Name:STOCKBURGER, STEPHANIE JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JEAN
Last Name:STOCKBURGER
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:UK ADOLESCENT MEDICINE
Mailing Address - Street 2:740 SOUTH LIMESTONE STREET, KENTUCKY CLINIC J-413
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-5643
Mailing Address - Fax:859-323-3795
Practice Address - Street 1:UK ADOLESCENT MEDICINE
Practice Address - Street 2:740 SOUTH LIMESTONE STREET, KENTUCKY CLINIC J-413
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-5643
Practice Address - Fax:859-323-3795
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY44727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics