Healthcare Provider Details

I. General information

NPI: 1245279819
Provider Name (Legal Business Name): THOMAS R. STUBBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 S SAM HOUSTON BLVD SUITE 300
HOUSTON MO
65483-2046
US

IV. Provider business mailing address

7917 MINERAL DR
HOUSTON MO
65483-1388
US

V. Phone/Fax

Practice location:
  • Phone: 417-967-5435
  • Fax: 417-967-5503
Mailing address:
  • Phone: 417-967-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR9C09
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: