Individual
KENNETH STEWART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1640 OLD PECOS TRL STE E, SANTA FE, NM 87505-4777
(505) 670-9778
Mailing address
1640 OLD PECOS TRL STE E, SANTA FE, NM 87505-4777
(505) 670-9778
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
91-318
NM
207Q00000X
Family Medicine Physician
91-318
NM
261QI0500X
Infusion Therapy Clinic/Center
Primary
91-318
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000R7779
—
NM
05
—
416182
—
AZ
Enumeration date
03/28/2006
Last updated
09/04/2024
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