Individual
MACK D STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
107 ROBERT E LEE DR, TYLER, TX 75703-4602
(903) 561-0300
Mailing address
107 ROBERT E LEE DR, TYLER, TX 75703-4602
(903) 561-0300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G8441
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0077EJ
BCBS
TX
05
—
137131207
—
TX
05
—
137131211
—
TX
05
—
137131212
—
TX
01
—
TIN PLUS 005
TRICARE JV LOCATION
TX
01
—
TIN PLUS 015
TRICARE TYLER LOCATION
TX
01
—
TIN PLUS 044
TRICARE WINNSBORO LOCATION
TX
Enumeration date
06/13/2006
Last updated
03/26/2020
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