Provider Demographics
NPI:1710086434
Name:TAYLOR, STEWART FERGUSON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:FERGUSON
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:108 E COOK ST
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-0320
Mailing Address - Country:US
Mailing Address - Phone:608-742-4242
Mailing Address - Fax:608-742-1931
Practice Address - Street 1:108 E COOK ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-0320
Practice Address - Country:US
Practice Address - Phone:608-742-4242
Practice Address - Fax:608-742-1931
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23326207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30335100Medicaid
B57080Medicare UPIN
WI30335100Medicaid