Provider Demographics
NPI:1285895920
Name:STEWART, JAMES DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:STEWART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:13462 W JESSE RED DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7904
Mailing Address - Country:US
Mailing Address - Phone:023-631-1166
Mailing Address - Fax:
Practice Address - Street 1:13462 W JESSE RED DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-7904
Practice Address - Country:US
Practice Address - Phone:602-363-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005591207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ623895Medicaid
AZZ147463Medicare PIN