Healthcare Provider Details

I. General information

NPI: 1033111703
Provider Name (Legal Business Name): STEPHEN GEORGE TYGART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 WHITESPORT DRIVE, SUITE 1
HUNTSVILLE AL
35801
US

IV. Provider business mailing address

165 WHITESPORT DRIVE, SUITE 1
HUNTSVILLE AL
35801
US

V. Phone/Fax

Practice location:
  • Phone: 256-881-4357
  • Fax: 256-881-4389
Mailing address:
  • Phone: 256-881-4357
  • Fax: 256-881-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10986
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10986
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: