Provider Demographics
NPI:1750424529
Name:STUBBLEFIELD, EARL T (MD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:T
Last Name:STUBBLEFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:291 E LAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9527
Mailing Address - Country:US
Mailing Address - Phone:601-936-9190
Mailing Address - Fax:601-932-6714
Practice Address - Street 1:291 E LAYFAIR DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9527
Practice Address - Country:US
Practice Address - Phone:601-936-9190
Practice Address - Fax:601-932-6714
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6032207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119442Medicaid
MS160000442Medicare ID - Type Unspecified
MS00119442Medicaid