Provider Demographics
NPI:1790089910
Name:STUBBLEFIELD, CURTIS RYAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:RYAN
Last Name:STUBBLEFIELD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WINDCREST ST
Mailing Address - Street 2:STE 210
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4480
Mailing Address - Country:US
Mailing Address - Phone:830-992-2880
Mailing Address - Fax:830-997-2028
Practice Address - Street 1:205 W WINDCREST ST STE 210
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4480
Practice Address - Country:US
Practice Address - Phone:830-997-4000
Practice Address - Fax:830-997-2028
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA10529363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX533583ZWS0Medicare PIN