Provider Demographics
NPI:1942336276
Name:STUART, ROGER G JR (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:G
Last Name:STUART
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2371
Mailing Address - Country:US
Mailing Address - Phone:903-572-1903
Mailing Address - Fax:903-572-1996
Practice Address - Street 1:2001 N JEFFERSON AVE
Practice Address - Street 2:STE 202
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2371
Practice Address - Country:US
Practice Address - Phone:903-572-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144511208800000X
TXF2467208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN4476OtherFL HF MEDICARE
FL111208700Medicaid