Provider Demographics
NPI:1093710832
Name:STEWART, COLIN C (MD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:C
Last Name:STEWART
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 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:205-297-9411
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-1900
Practice Address - Country:US
Practice Address - Phone:205-801-7396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000235332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942569Medicaid
AL511-60767OtherBLUE CROSS
AL009943062Medicaid
AL009911547Medicaid
AL171075Medicaid
AL515-42601OtherBLUE CROSS
AL515-54689OtherBLUE CROSS
AL7578605OtherAETNA
AL511-71007OtherBLUE CROSS
AL515-90397OtherBLUE CROSS
AL009984255Medicaid
AL051541323OtherBLUE CROSS
AL009910419Medicaid
AL515-41122OtherBLUE CROSS
AL051554689OtherBLUE CROSS
AL009984255Medicaid
AL510I300006Medicare PIN
ALP00135841Medicare PIN
H81358Medicare UPIN