Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 4301063760 | MI |
NPI | 1205823382 |
---|---|
Provider Name | James R Stubbart |
First Address | Grand Rapids, MI 49525 |
Second Address | Grand Rapids, MI 49525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 29/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200039789 | RR MEDICARE (01) | |
G39842 | (02) |