Provider Demographics
NPI:1770596041
Name:STUBBS, GINA RENEA (DO)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:RENEA
Last Name:STUBBS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746079
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9417 MESA DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-1253
Practice Address - Country:US
Practice Address - Phone:713-848-7780
Practice Address - Fax:833-710-0641
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220369207Q00000X
TXM3756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00903700Medicare ID - Type Unspecified
NY0204P1Medicare ID - Type Unspecified
H99020Medicare UPIN