Provider Demographics
NPI:1386644557
Name:STIRMAN, JERRY ARCHIBALD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ARCHIBALD
Last Name:STIRMAN
Suffix:JR
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 1:1101 DRESSER CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7327
Mailing Address - Country:US
Mailing Address - Phone:919-876-2010
Mailing Address - Fax:919-954-0555
Practice Address - Street 1:1101 DRESSER CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7327
Practice Address - Country:US
Practice Address - Phone:919-876-2010
Practice Address - Fax:919-954-0555
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000-23783208600000X
NC000023783208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8980094Medicaid
NC2043849Medicare PIN
C86615Medicare UPIN
NC210722Medicare PIN