Healthcare Provider Details

I. General information

NPI: 1760416309
Provider Name (Legal Business Name): HERMAN G. STUBBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4376 GERMANNA HWY
LOCUST GROVE VA
22508
US

IV. Provider business mailing address

4376 GERMANNA HWY
LOCUST GROVE VA
22508
US

V. Phone/Fax

Practice location:
  • Phone: 540-972-7798
  • Fax:
Mailing address:
  • Phone: 540-972-7798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101049469
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: