Healthcare Provider Details

I. General information

NPI: 1578887840
Provider Name (Legal Business Name): MICHAEL S. STUBBLEFIELD, MD. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6089 N 1ST ST STE 104
FRESNO CA
93710-5464
US

IV. Provider business mailing address

PO BOX 28915
FRESNO CA
93729-8915
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-3300
  • Fax: 559-439-2707
Mailing address:
  • Phone: 559-253-2800
  • Fax: 559-253-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA34392
License Number StateCA

VIII. Authorized Official

Name: TRACY BEBERIAN
Title or Position: MANAGER
Credential:
Phone: 559-253-2800