MEDICARE: DR. EDWARD MONTY STIRMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD 11282	TN
2	207Q00000X	Family Medicine Physician	0101030270	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043213994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD MONTY STIRMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37662-0009
Country	:	US
Telephone Number	:	423-857-2066
Fax Number	:	423-857-2070

Provider Business Practice Location Address
First Line	:	105 W STONE DR
Second Line	:	STE 3A
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3256
Country	:	US
Telephone Number	:	423-323-6200
Fax Number	:	423-323-6593

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/23/2009

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