Provider Demographics
NPI:1326886623
Name:STEWART, ROBERT DALE
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DALE
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520322
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:AK
Mailing Address - Zip Code:99652-0322
Mailing Address - Country:US
Mailing Address - Phone:907-570-1733
Mailing Address - Fax:833-846-5463
Practice Address - Street 1:1836 N PITTMAN RD UNIT B
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-9179
Practice Address - Country:US
Practice Address - Phone:907-570-1733
Practice Address - Fax:833-846-5463
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator