Healthcare Provider Details

I. General information

NPI: 1669458915
Provider Name (Legal Business Name): CLARENCE M STEWART III DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 NEW BERN AVE
RALEIGH NC
27610-1822
US

IV. Provider business mailing address

PO BOX 14759
RALEIGH NC
27620-4759
US

V. Phone/Fax

Practice location:
  • Phone: 919-231-7969
  • Fax: 919-231-7970
Mailing address:
  • Phone: 919-231-7969
  • Fax: 919-231-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number431
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: