Provider Demographics
NPI:1063565448
Name:STUBBS, G. WINSTON (MD)
Entity type:Individual
Prefix:DR
First Name:G.
Middle Name:WINSTON
Last Name:STUBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G.
Other - Middle Name:WINSTON
Other - Last Name:STUBBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, LTD
Mailing Address - Street 1:550 NW 79TH AVE
Mailing Address - Street 2:BLDG 55 APT 207
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4134
Mailing Address - Country:US
Mailing Address - Phone:215-248-2660
Mailing Address - Fax:215-248-5336
Practice Address - Street 1:550 NW 79TH AVE
Practice Address - Street 2:BLDG 55 APT 207
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-4134
Practice Address - Country:US
Practice Address - Phone:215-248-2660
Practice Address - Fax:215-248-5336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016469E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0742475Medicaid
PAB39740Medicare UPIN
PA0742475Medicaid