Doctor Name: | DR. DOUGLAS JEFFREY STABILE |
NPI Number: | 1467420059 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | 0103000774 |
Business Practice Address: | 1721 Financial Loop Lake Ridge, VA - 221922460 |
Business Phone Number: | 7034919500 |
Business Fax Number: | |
Mailing Address: | 1721 Financial Loop, LAKE RIDGE |
State: | VA |
Postal Code: | 221922460 |
Phone Number: | 7034919500 |
Fax Number: | |
NPI Enumeration Date: | 03/09/2006 |
NPI Last Update Date: | 08/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 0103000774 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |