Individual
GREGORY STIDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1107A BROOKDALE ST, MARTINSVILLE, VA 24112-4501
(276) 670-3300
Mailing address
1107A BROOKDALE ST, MARTINSVILLE, VA 24112-4501
(276) 670-3300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101-037121
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005632285
—
VA
05
—
5637759
—
VA
05
—
5637767
—
VA
Enumeration date
02/10/2006
Last updated
12/07/2020
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