Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 163 | AL |
NPI | 1497819536 |
---|---|
Provider Name | Douglas D Stewart |
First Address | Alexander City, AL 35010-4412 |
Second Address | Alexander City, AL 35010-4412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 23/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U61747 | (02) | AL |