Provider Demographics
NPI:1770803447
Name:STEWART, CHARLES MARTIN
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MARTIN
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18003 S ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-2391
Mailing Address - Country:US
Mailing Address - Phone:501-517-2141
Mailing Address - Fax:
Practice Address - Street 1:18003 S ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002-2391
Practice Address - Country:US
Practice Address - Phone:501-517-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic