Provider Demographics
NPI:1063903003
Name:ENGELHARD, STEPHANIE BETH (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BETH
Last Name:ENGELHARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 COATSLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3908
Mailing Address - Country:US
Mailing Address - Phone:731-427-7799
Mailing Address - Fax:731-427-1476
Practice Address - Street 1:328 COATSLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3908
Practice Address - Country:US
Practice Address - Phone:731-427-7799
Practice Address - Fax:731-427-1476
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR76834207R00000X
CAA177825207W00000X
TNMD70108207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine