Provider Demographics
NPI:1124165428
Name:STEWART, JULIE ELIZABETH (DPM)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ELIZABETH
Last Name:STEWART
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12672 MATEUS DR
Mailing Address - Street 2:APT. D
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2349
Mailing Address - Country:US
Mailing Address - Phone:314-485-1225
Mailing Address - Fax:
Practice Address - Street 1:300 WINDING WOODS DR
Practice Address - Street 2:SUITE214
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4771
Practice Address - Country:US
Practice Address - Phone:636-281-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006033772213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery