Provider Demographics
NPI:1104551720
Name:STEWART, JEFFREY A (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:STEWART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 582165
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0037
Mailing Address - Country:US
Mailing Address - Phone:707-704-0357
Mailing Address - Fax:916-745-4664
Practice Address - Street 1:7733 GINGERBLOSSOM DR
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1919
Practice Address - Country:US
Practice Address - Phone:916-745-4664
Practice Address - Fax:916-745-4664
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85-2000467311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home