Provider Demographics
NPI:1285693929
Name:FERN, STEWART A
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:A
Last Name:FERN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STEWART
Other - Middle Name:A
Other - Last Name:FERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:PETERSON
Mailing Address - State:IA
Mailing Address - Zip Code:51047-0194
Mailing Address - Country:US
Mailing Address - Phone:712-295-7010
Mailing Address - Fax:
Practice Address - Street 1:1251 W CEDAR LOOP
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1566
Practice Address - Country:US
Practice Address - Phone:712-225-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-2806F2084P0800X
IA274002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE47264Medicaid
OH000000328171OtherANTHEM PIN
OHY108663OtherTHE HEALTH PLAN PIN
OH307823OtherTRICARE/MHN PIN
OH7771497OtherAETNA PIN
OH108663000OtherMAGELLAN PIN
OH2379706Medicaid
OHE47264Medicaid
OH2379706Medicaid