Individual
JACK O. STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1310 W STEWART DR STE 408, ORANGE, CA 92868-3855
(714) 639-9401
(714) 919-8807
Mailing address
1010 W LA VETA AVE STE 750, ORANGE, CA 92868-4312
(714) 361-6600
(714) 919-8804
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
G48397
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912919804
NPI - TYPE 2
CA
01
—
290003382
RAIL ROAD MEDICARE - PROVIDER PTAN
CA
01
—
CG5665
RAIL ROAD MEDICARE - GROUP PTAN
CA
01
—
W1514
MEDICARE PTAN - TYPE 2
CA
01
—
WG48397D
PTAN
CA
Enumeration date
03/09/2006
Last updated
07/21/2022
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