Provider Demographics
NPI:1932377249
Name:JUBINSKI, STEPHEN JR (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:JUBINSKI
Suffix:JR
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 1:629 GREEN HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1892
Mailing Address - Country:US
Mailing Address - Phone:618-257-2271
Mailing Address - Fax:
Practice Address - Street 1:1512 N GREEN MOUNT RD
Practice Address - Street 2:SUITE 108
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1953
Practice Address - Country:US
Practice Address - Phone:618-624-5510
Practice Address - Fax:618-624-5529
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008004462207Q00000X
IL036.119375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine