Provider Demographics
NPI:1194729004
Name:STUART, STEPHEN BRUCE (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BRUCE
Last Name:STUART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:STUART
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:804 AINSWORTH DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1624
Mailing Address - Country:US
Mailing Address - Phone:928-776-0601
Mailing Address - Fax:928-776-0620
Practice Address - Street 1:804 AINSWORTH DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1624
Practice Address - Country:US
Practice Address - Phone:928-776-0601
Practice Address - Fax:928-776-0620
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34286207RC0000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ499972Medicaid
AZP00249737OtherRAILROAD MEDICARE
AZ499972Medicaid
AZZ132182Medicare PIN
AZZ105016Medicare PIN
AZ499972Medicaid
NM343401401Medicare PIN
E90060Medicare UPIN