Provider Demographics
NPI:1831330893
Name:STIGALL, LANDON EVERETT (MD)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:EVERETT
Last Name:STIGALL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1450 PROFESSIONAL PARK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1307
Mailing Address - Country:US
Mailing Address - Phone:336-724-2434
Mailing Address - Fax:336-724-6123
Practice Address - Street 1:6752 ROCK SPRING RD STE 201
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405
Practice Address - Country:US
Practice Address - Phone:910-782-0028
Practice Address - Fax:910-765-7488
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2018-06-13
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Provider Licenses
StateLicense IDTaxonomies
TNMD51543207ND0101X
NC2017-00729207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCX252C511OtherMEDICARE