Provider Demographics
NPI:1073034443
Name:STUART, SAMUEL D (CPO)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:D
Last Name:STUART
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:MR
Other - First Name:SAM
Other - Middle Name:D
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPO
Mailing Address - Street 1:401 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4344
Mailing Address - Country:US
Mailing Address - Phone:336-885-6565
Mailing Address - Fax:336-885-6579
Practice Address - Street 1:401 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4344
Practice Address - Country:US
Practice Address - Phone:336-885-6565
Practice Address - Fax:336-885-6579
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO03809OtherABC