Provider Demographics
NPI:1275613218
Name:STEWART, RUSSELL M III (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:M
Last Name:STEWART
Suffix:III
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 1:1269 US HIGHWAY 221A
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-5921
Mailing Address - Country:US
Mailing Address - Phone:828-657-5371
Mailing Address - Fax:828-657-9190
Practice Address - Street 1:1269 US HIGHWAY 221A
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-5921
Practice Address - Country:US
Practice Address - Phone:828-657-5371
Practice Address - Fax:828-657-9190
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27137207Q00000X
NC2014-01967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFS3173476OtherDEA
NCFS3173476OtherDEA
D5655Medicare UPIN