Organization
PATRICK WAYNE STEWART
Active
Parent organization
PATRICK WAYNE STEWART
Organization subpart
Yes
Provider details
NPI number
Legal business name
PATRICK WAYNE STEWART
Authorized official
PATRICKWAYNE STEWART X (CHIEF EXECUTIVE ADMINISTRATOR)
(602) 881-7023
Entity
Organization
Contact information
Practice address
1621 E JACINTO AVE, 6895, MESA, AZ 85204-6895
(602) 881-7023
Mailing address
1621 E JACINTO AVE, P.O. BOX 6895, MESA, AZ 85204-6895
(602) 881-7023
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
21090395
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D03746851
CUSTOMER
AZ
Enumeration date
11/04/2016
Last updated
11/04/2016
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