Provider Demographics
NPI:1841470176
Name:STUART, JONATHAN MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:STUART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-259-1673
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:3045 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133
Practice Address - Country:US
Practice Address - Phone:901-381-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-03
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204152208100000X
TN34242081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT03386AOtherMEDICARE TENNESSEE
TN1076472OtherABMS
TNP02096090OtherRAILROAD MEDICARE
TN6154827OtherBLUE CROSS TN
TN710872OtherAAPM&R