Provider Demographics
NPI:1104870567
Name:STEWART, JAMES H (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:STEWART
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7733 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9020
Mailing Address - Country:US
Mailing Address - Phone:208-376-3220
Mailing Address - Fax:208-322-7370
Practice Address - Street 1:7733 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-376-3220
Practice Address - Fax:208-322-7370
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6826207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDF23151Medicare UPIN