Provider Demographics
NPI:1225192099
Name:STUART, WAYNE J (DO)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:J
Last Name:STUART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:10626 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4703
Practice Address - Country:US
Practice Address - Phone:865-577-5231
Practice Address - Fax:865-577-1539
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO000645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5868381OtherAETNA
TN3301477Medicare ID - Type Unspecified
TN3301476Medicaid
0140100OtherUNITED HEALTHCARE
3149846OtherBCBS
TNF05757Medicare UPIN