Healthcare Provider Details

I. General information

NPI: 1366436644
Provider Name (Legal Business Name): JAMES STUBBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 GRAND ARMY HWY
SOMERSET MA
02726-1220
US

IV. Provider business mailing address

67 GRAND ARMY HWY
SOMERSET MA
02726-1220
US

V. Phone/Fax

Practice location:
  • Phone: 508-678-5633
  • Fax: 508-673-5605
Mailing address:
  • Phone: 508-678-5633
  • Fax: 508-673-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39193
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: