Individual
DR. TED JUSTIN STIDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1611 27TH ST STE 101, PORTSMOUTH, OH 45662-6932
(740) 356-7337
(740) 356-6304
Mailing address
1735 27TH ST STE B06, PORTSMOUTH, OH 45662-2681
(740) 356-8681
(740) 353-7900
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35.120739
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0106413
—
OH
Enumeration date
03/25/2011
Last updated
12/16/2020
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