Provider Demographics
NPI:1760414361
Name:COUCH, STEWART MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:MARTIN
Last Name:COUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2409 RING RD.
Mailing Address - Street 2:STE. 114
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-982-3344
Mailing Address - Fax:270-982-3366
Practice Address - Street 1:2409 RING RD.
Practice Address - Street 2:STE. 114
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-982-3344
Practice Address - Fax:270-982-3366
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY287312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64287311Medicaid
KYF31313Medicare UPIN
KY64287311Medicaid