Individual
DANIEL STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
813 W THIRD ST, FOREST, MS 39074-4006
(601) 469-1001
Mailing address
119 1ST ST SE, PO BOX 426, MAGEE, MS 39111-3673
(601) 849-4112
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0480
MS
Other
Enumeration date
02/04/2010
Last updated
02/04/2010
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