Provider Demographics
NPI:1497819536
Name:STEWART, DOUGLAS D (DPM)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:D
Last Name:STEWART
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 HIGHWAY 22 W STE 1
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-4412
Mailing Address - Country:US
Mailing Address - Phone:256-215-5596
Mailing Address - Fax:256-215-5551
Practice Address - Street 1:1649 HIGHWAY 22 WEST
Practice Address - Street 2:SUITE ONE
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4412
Practice Address - Country:US
Practice Address - Phone:256-215-5596
Practice Address - Fax:256-215-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL163213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1237910001Medicare NSC
ALU61747Medicare UPIN
AL000038828Medicare ID - Type Unspecified