Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 3570 | AL |
NPI | 1740261346 |
---|---|
Provider Name | Dr. Robert Edley Stewart |
First Address | Huntsville, AL 35801-4315 |
Second Address | Huntsville, AL 35801-4315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06133 | BCBS PROVIDER NUMBER (01) | AL |
F58170 | (02) | AL |