Provider Demographics
NPI:1144487109
Name:STUBBS, WILL (DO)
Entity type:Individual
Prefix:
First Name:WILL
Middle Name:
Last Name:STUBBS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4256
Mailing Address - Country:US
Mailing Address - Phone:814-534-3745
Mailing Address - Fax:814-534-5677
Practice Address - Street 1:1086 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4256
Practice Address - Country:US
Practice Address - Phone:814-534-3745
Practice Address - Fax:814-534-5677
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012334207P00000X
TXP3673207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine