Provider Demographics
NPI:1851336150
Name:STUBBE, HERMANN J (MD)
Entity Type:Individual
Prefix:
First Name:HERMANN
Middle Name:J
Last Name:STUBBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 N CORPORATE LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3211
Mailing Address - Country:US
Mailing Address - Phone:954-349-1111
Mailing Address - Fax:954-349-1234
Practice Address - Street 1:1825 N CORPORATE LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3211
Practice Address - Country:US
Practice Address - Phone:954-349-1111
Practice Address - Fax:954-349-1234
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1004444207QG0300X
PR14135207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020886STOtherTRIPLES PROVIDER NUMBER
FL280158200Medicaid
PR0020886Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL280158200Medicaid