Basic Information
| Provider Information | |||||||||
| NPI: | 1578546644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRUBLE | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | GRAHAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 PARKWAY OFFICE CT | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275187423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192770427 | ||||||||
| FaxNumber: | 9192334492 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 PARKWAY OFFICE CT | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275187423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192770427 | ||||||||
| FaxNumber: | 9192334492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0101240060 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 200500675 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5901028 | 05 | NC | MEDICAID | N0067C | 05 | SC | MEDICAID |