Individual
STEWART C. GREATHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
217 SAM HOUSTON JONES PKWY, STE 104, LAKE CHARLES, LA 70611-5644
(337) 480-8989
(337) 480-8988
Mailing address
PO BOX 122539 DEPT 2539, DALLAS, TX 75312-2539
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.205459
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2150278
—
LA
01
—
MD.205459
STATE MEDICAL LICENSE
LA
Enumeration date
03/18/2011
Last updated
04/27/2022
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