Healthcare Provider Details

I. General information

NPI: 1043292840
Provider Name (Legal Business Name): MEREDITH B STUART DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16087 MANCHESTER RD
ELLISVILLE MO
63011-2103
US

IV. Provider business mailing address

16087 MANCHESTER RD
ELLISVILLE MO
63011-2103
US

V. Phone/Fax

Practice location:
  • Phone: 636-230-3883
  • Fax: 636-230-3884
Mailing address:
  • Phone: 636-230-3883
  • Fax: 636-230-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number9410M1973
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: