Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 13449 | TN |
NPI | 1821068040 |
---|---|
Provider Name | Dr. William Robert Stewart JR. |
First Address | Columbia, TN 38401-4659 |
Second Address | Columbia, TN 38401-6420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 17/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3710089 | (05) | TN |
D74284 | (02) | TN |