MEDICARE: DR. STUART A NAULTY D.P.M.

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	213E00000X	Podiatrist	00160	KY

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	000000052090	OTHER	KY	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235241696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART A NAULTY D.P.M.

Provider Business Mailing Address
First Line	:	908 B SOUTH 12TH ST
Second Line	:
City	:	MURRAY
State	:	KY
Zip	:	42071-2949
Country	:	US
Telephone Number	:	270-753-0666
Fax Number	:	270-753-0684

Provider Business Practice Location Address
First Line	:	908 B SOUTH 12TH ST
Second Line	:
City	:	MURRAY
State	:	KY
Zip	:	42071-2949
Country	:	US
Telephone Number	:	270-753-0666
Fax Number	:	270-753-0684

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/23/2007

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