Individual provider Active NPI

Earl T Stubblefield, MD

  • Gynecology Physician
  • Flowood, MS
National Provider Identifier
1750424529
Registry record updated Apr 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
6032 Issued in MS
Practice address
291 E Layfair Dr
Flowood, MS 39232-9527
Phone
(601) 936-9190
Fax
(601) 932-6714
NPI assigned
Feb 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 6032 MS Primary

Addresses

Primary practice location

291 E Layfair Dr
Flowood, MS 39232-9527

Mailing address

291 E Layfair Dr
Flowood, MS 39232-9527
Phone (601) 936-9190

Other identifiers 1

IdentifierTypeStateIssuer
00119442MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6032MSMDGynecology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303257600000",
    "number": "1750424529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 E LAYFAIR DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329527",
            "telephone_number": "601-936-9190",
            "fax_number": "601-932-6714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 E LAYFAIR DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329527",
            "telephone_number": "601-936-9190",
            "fax_number": "601-932-6714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUBBLEFIELD",
        "first_name": "EARL",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2011-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "MS",
            "license": "6032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00119442",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.