Healthcare Provider Details

I. General information

NPI: 1164535498
Provider Name (Legal Business Name): JOHN STUART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 STONEWALL ST
MEMPHIS TN
38112-5144
US

IV. Provider business mailing address

232 STONEWALL ST
MEMPHIS TN
38112-5144
US

V. Phone/Fax

Practice location:
  • Phone: 901-577-7266
  • Fax: 901-577-7273
Mailing address:
  • Phone: 901-577-7266
  • Fax: 901-577-7273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD6967
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: