Organization
PATRICK WAYNE STEWART
Active
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
Update your record
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