Individual
DUSTIN STIDGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1327 TROUP HWY, TYLER, TX 75701-4443
(903) 606-2100
Mailing address
1327 TROUP HWY, TYLER, TX 75701-4443
(903) 606-2100
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
R5041
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
817183
MEDICARE
TX
Enumeration date
04/15/2014
Last updated
07/29/2019
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