STEPHEN BLACKSTONE EDSTROM (NPI# 1396942264) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396942264 |
| Entity Type | Individual |
| Full Name | STEPHEN BLACKSTONE EDSTROM |
| Credential | M.D. |
| Practice Address |
300 Twining St Bldg 760 Montgomery AL 36112-6027 |
| Practice Telephone | 3349535143 |
| Mailing Telephone | 3349535143 |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2018-03-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01066091A | IN | Allopathic & Osteopathic Physicians |
| Street Address |
300 TWINING ST BLDG 760 |
| City | MONTGOMERY |
| State | AL |
| Zip Code | 36112-6027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609874882 | Thomas M Goodman | Family Medicine | 300 Twining St Bldg 760, Montgomery, AL 36112-6027 | 2005-07-12 |
| 1386291136 | Joshua Cleaver | Pharmacist | 300 Twining St Bldg 760, Montgomery, AL 36112-6027 | 2019-08-26 |
| 1790288900 | Amber West | Pharmacist | 300 Twining St Bldg 760, Montgomery, AL 36112-6027 | 2018-03-14 |
| 1902321458 | Preston Durham Shurley | Dentist | 300 Twining St Bldg 760, Montgomery, AL 36112 | 2017-08-06 |
| 1053853002 | Andrea Pierce | Dentist | 300 Twining St Bldg 760, Montgomery, AL 36112 | 2016-11-08 |
| 1568840445 | Aphton Brooke Lane | Pediatrics | 300 Twining St Bldg 760, Montgomery, AL 36112 | 2015-05-12 |
| 1386056992 | Eric L Wilder | Family Medicine | 300 Twining St Bldg 760, Montgomery, AL 36112-6027 | 2014-05-30 |
| 1023359940 | Amanda Simmons Duty | Optometrist | 300 Twining St Bldg 760, Montgomery, AL 36112-6027 | 2013-03-04 |
| 1386948487 | Roshanda Hogue Gaddis | Dietitian, Registered | 300 Twining St Bldg 760, Montgomery, AL 36112-6027 | 2011-01-04 |
| 1306152715 | Cheryl A Stulzaft | Social Worker | 300 Twining St Bldg 760, Montgomery, AL 36112-6027 | 2010-08-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841836970 | Alison Bees Thompson | Social Worker | 42nd Medical Group, 300 S. Twining St. Bldg 760, Maxwell Afb, AL 36112 | 2019-11-25 |
| 1881245967 | Grant M Golombeski | Military Health Care Provider | 300 S Twinning Dr., Apo, AA 36112 | 2019-09-20 |
| 1477015196 | Jennifer Marie Hudson | Counselor | Jennifer Hudson, 300 South Twining St Bldg 760, Maxwell Afb, AL 36112 | 2019-04-02 |
| 1255801049 | Jose Edwin Aviles | Military Health Care Provider | Kelly Street, Montgomery, AL 36112 | 2018-12-05 |
| 1306316963 | Lydia Price Beringer | Speech-Language Pathologist | 300 S. Twining Street 42 Nd Medical Group, Maxwell Afb, AL 36112 | 2018-11-27 |
| 1114431301 | Dean M Kot | Physician Assistant | Mxf, Kelly St, Apo, AA 36112 | 2017-11-27 |
| 1417353590 | Jamie Ellis | Social Worker | 300 S. Twining St. Bldg 760, Maxwell Afb, AL 36112 | 2014-11-17 |
| 1629419650 | Elias N Hydrick | Family Medicine | 300 S. Twining St., Bldg 760, Maxwell Afb, 42nd Medical Group, Montgomery, AL 36112 | 2013-07-06 |
| 1639454200 | Sharon Lewis | Pharmacist | 300 Southtwining St, Montgomery, AL 36112 | 2011-10-14 |
| 1104158518 | Sylvia Ann Newell | Dietitian, Registered | 50 W Ash St Bldg 841, Montgomery, AL 36112 | 2010-02-10 |
| Find all providers in zip 36112 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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| 1952919490 | Age Well Concierge Medicine | Family Medicine | 18441 Tx-105, Suite B, Montgomery, TX 77356 | 2020-07-21 |
| 1992313670 | Integrated Medical Care Pllc | Family Medicine | 10427 Twin Circles Dr, Montgomery, TX 77356-4704 | 2020-07-17 |
| 1750906921 | Doctors Making Home Visits 1st Inc | Family Medicine | 922 S Perry St, Montgomery, AL 36104-5022 | 2020-06-12 |
| 1508496688 | Montgomery General Hospital, Inc | Family Medicine | 401 6th Ave Ste 301, Montgomery, WV 25136-2116 | 2020-01-17 |
| 1427521962 | Health Services, Inc | Family Medicine | 2801 Willena Ave, Montgomery, AL 36107-1055 | 2019-01-08 |
| 1750869814 | Nina Yvette Massey | Family Medicine | Baptist South Uab Multi Specialty Clinic, 2119 E. South Blvd, Montgomery, AL 36116 | 2018-08-01 |
| 1871010223 | Micah Bosley Md, Pllc | Family Medicine | 102 Piping Rock Dr, Montgomery, TX 77356-5860 | 2017-08-26 |
| 1003267899 | Your Doctor's Office, PC | Family Medicine | 8630 Vaughn Rd, Montgomery, AL 36117-8852 | 2016-06-23 |
| 1194175513 | Miho Suga | Family Medicine | 1801 Pine St Ste 301, Montgomery, AL 36106-1154 | 2016-06-16 |
| 1265834618 | Sarah Elizabeth Connors | Family Medicine | 4150 Carmichael Rd Ste B, Montgomery, AL 36106-2933 | 2014-09-17 |
| Find all providers in MONTGOMERY | ||||
| City | MONTGOMERY |
| Zip Code | 36112 |
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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.