Individual
STEWART QUISLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3340 TULLY RD, D-2, MODESTO, CA 95350-0838
(209) 523-5195
(209) 523-5197
Mailing address
220 STANDIFORD AVE, SUITE F, MODESTO, CA 95350-1159
(209) 579-5628
(209) 579-5637
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
C323000
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
770388035
BLUE SHIELD
CA
Enumeration date
08/31/2006
Last updated
03/04/2010
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