Individual
JACK O. STEWART
Active
Individual
JACK O. STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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