Provider Demographics
NPI:1285821397
Name:STIDHAM, JEREMY VERBON (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:VERBON
Last Name:STIDHAM
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 1:1890 AL HIGHWAY 157
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-3601
Mailing Address - Country:US
Mailing Address - Phone:256-737-8000
Mailing Address - Fax:256-737-8058
Practice Address - Street 1:1890 AL HIGHWAY 157
Practice Address - Street 2:SUITE 300
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-3601
Practice Address - Country:US
Practice Address - Phone:256-737-8000
Practice Address - Fax:256-737-8058
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL28400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine