MEDICARE: NOEL STUBBS

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	177F00000X	Lodging Provider		OK
2	347C00000X	Private Vehicle		OK

General Provider Information

NPI Number	:	1134335771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEL STUBBS

Provider Business Mailing Address
First Line	:	RR 1 BOX 239
Second Line	:
City	:	GORE
State	:	OK
Zip	:	74435-9510
Country	:	US
Telephone Number	:	918-487-5452
Fax Number	:

Provider Business Practice Location Address
First Line	:	RR 1 BOX 239
Second Line	:
City	:	GORE
State	:	OK
Zip	:	74435-9510
Country	:	US
Telephone Number	:	918-487-5452
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	09/11/2025

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Directions to “ NOEL STUBBS ” Practice Location

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