Provider Demographics
NPI:1215971338
Name:STUBBLEFIELD, SANDRA CAROLE (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:CAROLE
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:CAROLE
Other - Last Name:STUBBLEFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-936-8000
Mailing Address - Fax:870-932-1293
Practice Address - Street 1:8170 US HIGHWAY 49N
Practice Address - Street 2:
Practice Address - City:BROOKLAND
Practice Address - State:AR
Practice Address - Zip Code:72417
Practice Address - Country:US
Practice Address - Phone:870-936-8000
Practice Address - Fax:870-932-1293
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119256001Medicaid
080045762OtherRAILROAD MEDICARE
080045762OtherRAILROAD MEDICARE
ARE83372Medicare UPIN