Individual
MARY ELAINE STAUBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
401 E CHESTNUT ST, SUITE 410, LOUISVILLE, KY 40202-5700
(502) 271-5999
(502) 271-5994
Mailing address
PO BOX 909, DEPT OB/GYN ATT VICKI MASTERSON, LOUISVILLE, KY 40201-0909
(502) 588-0329
(502) 588-0326
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
21058
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000368677
ANTHEM
—
01
—
000000507070
ANTHEM
—
05
—
200835760
—
IN
01
—
50006479
PASSPORT SPECIALTY
KY
01
—
50015262
PASSPORT SPECIALTY
KY
01
—
50017317
PASSPORT PCP
KY
05
—
64210586
—
KY
Enumeration date
12/05/2005
Last updated
11/29/2016
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