Individual
GREGORY P STIDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 23RD ST NW, FAYETTE, AL 35555-1001
(205) 932-3891
(205) 932-3996
Mailing address
110 23RD ST NW, FAYETTE, AL 35555-1001
(205) 932-3891
(205) 932-3996
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00021977
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009928080
—
AL
01
—
630936460
TAX ID
AL
Enumeration date
08/31/2005
Last updated
02/18/2013
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