Provider Demographics
NPI:1679800635
Name:DENNIS O. STUART, PLLC
Entity Type:Organization
Organization Name:DENNIS O. STUART, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-738-3957
Mailing Address - Street 1:109 SHORT DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-8217
Mailing Address - Country:US
Mailing Address - Phone:910-738-3957
Mailing Address - Fax:910-738-7354
Practice Address - Street 1:103 W 27TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3014
Practice Address - Country:US
Practice Address - Phone:910-738-3957
Practice Address - Fax:910-738-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC80693OtherBCBSNC
NCA15705Medicare UPIN
NC2191687KMedicare PIN