MEDICARE: G. WINSTON STUBBS M.D., LTD

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	261QS0132X	Ophthalmologic Surgery Clinic/Center	MD016469E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770709164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G. WINSTON STUBBS M.D., LTD

Provider Business Mailing Address
First Line	:	8121 STENTON AVE # B
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3530
Country	:	US
Telephone Number	:	215-248-2660
Fax Number	:	215-248-5336

Provider Business Practice Location Address
First Line	:	8121 STENTON AVE # B
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3530
Country	:	US
Telephone Number	:	215-248-2660
Fax Number	:	215-248-5336

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. G. WINSTON STUBBS
Credential	:	M.D.
Telephone Number	:	215-248-2660

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/07/2008

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