MEDICARE: JAMES STUBBERT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	39193	MA

General Provider Information

NPI Number	:	1366436644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES STUBBERT M.D.

Provider Business Mailing Address
First Line	:	67 GRAND ARMY HWY
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02726-1220
Country	:	US
Telephone Number	:	508-678-5633
Fax Number	:	508-673-5605

Provider Business Practice Location Address
First Line	:	67 GRAND ARMY HWY
Second Line	:
City	:	SOMERSET
State	:	MA
Zip	:	02726-1220
Country	:	US
Telephone Number	:	508-678-5633
Fax Number	:	508-673-5605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	04/02/2008

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