Provider Demographics
NPI:1417126541
Name:WILLIAM C. STEWART, JR., M.D. PLLC
Entity Type:Organization
Organization Name:WILLIAM C. STEWART, JR., M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-275-8280
Mailing Address - Street 1:795 RIDGE LAKE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9475
Mailing Address - Country:US
Mailing Address - Phone:901-275-8280
Mailing Address - Fax:901-275-8283
Practice Address - Street 1:795 RIDGE LAKE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9475
Practice Address - Country:US
Practice Address - Phone:901-275-8280
Practice Address - Fax:901-275-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMDO19833207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE02354Medicare UPIN