Provider Demographics
NPI:1043213994
Name:STIRMAN, EDWARD MONTY (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MONTY
Last Name:STIRMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:STE 3A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3256
Practice Address - Country:US
Practice Address - Phone:423-323-6200
Practice Address - Fax:423-323-6593
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 11282207Q00000X
VA0101030270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5610265Medicaid
TN3172037Medicaid
TN0281780001Medicare PIN
TN080019150Medicare PIN
TN3172037Medicare ID - Type Unspecified
TN103I086169Medicare UPIN
VA5610265Medicaid
TN0281780003Medicare PIN
B59364Medicare UPIN
TN3700592Medicare PIN