Provider Demographics
NPI:1255371126
Name:STUBBS, GARRY WAYNE (MD)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:WAYNE
Last Name:STUBBS
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 1:4201 WEST BEE CAVES RD
Mailing Address - Street 2:SUITE B112
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-327-4886
Mailing Address - Fax:512-327-4958
Practice Address - Street 1:4201 WEST BEE CAVES RD
Practice Address - Street 2:SUITE B112
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-327-4886
Practice Address - Fax:512-327-4958
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8442207L00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8A2421OtherMEDICARE ID
TX123450206Medicaid
TXF51670Medicare UPIN
TX123450206Medicaid