Provider Demographics
NPI:1740261346
Name:STEWART, ROBERT EDLEY (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDLEY
Last Name:STEWART
Suffix:
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 1:115 MANNING DR SW
Mailing Address - Street 2:SUITE A101
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4315
Mailing Address - Country:US
Mailing Address - Phone:256-533-1030
Mailing Address - Fax:256-533-1043
Practice Address - Street 1:115 MANNING DR SW
Practice Address - Street 2:SUITE A101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4315
Practice Address - Country:US
Practice Address - Phone:256-533-1030
Practice Address - Fax:256-533-1043
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3570204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL06133OtherBCBS PROVIDER NUMBER
ALF58170Medicare UPIN