BRYAN DWAYNE STUP (NPI# 1063702165) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063702165 |
| Entity Type | Individual |
| Full Name | BRYAN DWAYNE STUP |
| Credential | MD |
| Practice Address |
2706 Medical Office Pl Goldsboro NC 27534-9460 |
| Practice Telephone | 9197344736 |
| Mailing Telephone | 9197344736 |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2014-07-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 2014-00559 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | FS4441147 | 01 |
| Street Address |
2706 MEDICAL OFFICE PL |
| City | GOLDSBORO |
| State | NC |
| Zip Code | 27534-9460 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295718682 | Mary Eileen Maloy Witt | Nurse Practitioner | 2706 Medical Office Pl, Goldsboro, NC 27534-9460 | 2005-11-21 |
| 1124649769 | Chelsey Erica Smith | Nurse Practitioner | 2706 Medical Office Pl, Goldsboro, NC 27534-9462 | 2020-05-06 |
| 1568823003 | Ashley Worley | Nurse Practitioner | 2706 Medical Office Pl, Goldsboro, NC 27534-9460 | 2016-03-11 |
| 1033456991 | Katie Michelle Anthony | Nurse Practitioner | 2706 Medical Office Pl, Goldsboro, NC 27534-9460 | 2013-01-12 |
| 1598049843 | Lane Natividad | Nurse Practitioner | 2706 Medical Office Pl, Goldsboro, NC 27534-9460 | 2011-10-05 |
| 1508055872 | Amy G. E. Brantley | Physician Assistant | 2706 Medical Office Pl, Goldsboro, NC 27534-9460 | 2007-10-23 |
| 1912076688 | Frances Maureen Ballentine | Nurse Practitioner | 2706 Medical Office Pl, Goldsboro, NC 27534-9460 | 2006-11-07 |
| 1336230663 | Michelle Carter Thrailkill | Social Worker | 2706 Medical Office Pl, Goldsboro, NC 27534-9460 | 2006-09-28 |
| 1760491781 | Jennifer Jarrett Hoover | Pediatrics | 2706 Medical Office Pl, Goldsboro, NC 27534-9460 | 2006-08-07 |
| 1942260294 | Katherine Tayloe Macdonald | Pediatrics | 2706 Medical Office Pl, Goldsboro, NC 27534-9460 | 2006-03-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457875767 | Trent Jonathan Forshey | Physical Therapist | 2126 Wayne Memorial Dr, Goldsboro, NC 27534 | 2017-07-28 |
| 1336685551 | Wayne Al Holdings, LLC | Assisted Living Facility | 901 West New Hope Rd, Goldsboro, NC 27534 | 2017-01-11 |
| 1952845471 | Latoya Faulk | Social Worker | 121 Carolina Forest Drive, Goldsboro, NC 27534 | 2016-12-19 |
| 1528415841 | Kelby Joseph Sage Durnin | Military Health Care Provider | 1020 Jabara Avenue, Seymour Johnson Afb, NC 27534 | 2016-05-17 |
| 1528490604 | Eric Christian Bourgeois | Physical Therapist | 1101a Gracie Pl, Goldsboro, NC 27534 | 2013-07-31 |
| 1831439165 | Erica Nicole Davis | Optometrist | 20/20 Vision Center 625 North Berkeley Blvd, Suite D, Goldsboro, NC 27534 | 2013-02-23 |
| 1891039236 | Betty Webb Zimmerman | Nurse Practitioner | 204 Cox Blvd, Goldsboro, NC 27534 | 2012-11-26 |
| 1144595265 | Life Recovery Psychological Services | Counselor | 1202-c Wayne Memorial Dr, Goldsboro, NC 27534 | 2012-03-22 |
| 1558596536 | Taylor Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 802 Taylor St, Goldsboro, NC 27534 | 2009-05-20 |
| 1780895136 | Sherrie Fennell Edwards | Dietitian, Registered | 1500 Lanely Ave., Seymour Johnson Afb, Golsboro, NC 27534 | 2007-05-25 |
| Find all providers in zip 27534 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689108508 | Peri Fouss | Pediatrics | 2803 Medical Campus Drive, Goldsboro, NC 27531 | 2017-04-18 |
| 1326115171 | Michelle C Larson | Pediatrics | 2706 Medical Office Plaza, Goldsboro, NC 27534-9460 | 2006-11-29 |
| 1871538785 | Joseph W Ponzi | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534-9460 | 2006-06-17 |
| 1538432018 | Elliott John Sally | Pediatrics | 1050 Jabara Ave, Sjafb, Pediatric Clinic, Goldsboro, NC 27531-2310 | 2012-02-15 |
| 1588954721 | Elisabeth Ann Heiser Stup | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534 | 2011-04-08 |
| 1386820256 | Mdfamily Medical Group | Pediatrics | 1802 E Ash St, Goldsboro, NC 27530-4045 | 2008-01-10 |
| 1679640429 | Carey Ziemer | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534-9460 | 2006-11-29 |
| 1588731335 | Christopher P Griffin | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534-9460 | 2006-11-29 |
| 1427125269 | Goldsboro Pediatrics Pa | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534-9460 | 2006-11-29 |
| 1932276797 | Erika S Boyd | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534-9460 | 2006-11-29 |
| Find all providers in GOLDSBORO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.