Provider Demographics
NPI:1033111703
Name:TYGART, STEPHEN GEORGE (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GEORGE
Last Name:TYGART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WHITESPORT DRIVE, SUITE 1
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-881-4357
Mailing Address - Fax:256-881-4389
Practice Address - Street 1:165 WHITESPORT DRIVE, SUITE 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-881-4357
Practice Address - Fax:256-881-4389
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10986207V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000080544Medicaid
AL528501500Medicaid