Provider Demographics
NPI:1669458915
Name:STEWART, CLARENCE M III (DPM)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:M
Last Name:STEWART
Suffix:III
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:PO BOX 14759
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-4759
Mailing Address - Country:US
Mailing Address - Phone:919-231-7969
Mailing Address - Fax:919-231-7970
Practice Address - Street 1:2701 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1822
Practice Address - Country:US
Practice Address - Phone:919-231-7969
Practice Address - Fax:919-231-7970
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC431213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08039OtherBCBS
NC8905939Medicaid
NC2433420BMedicare ID - Type UnspecifiedMEDICARE
NC8905939Medicaid