Provider Demographics
NPI:1386706091
Name:STEWART, PATRICIA ANN (DO)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16461 DOMESTIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-2899
Mailing Address - Country:US
Mailing Address - Phone:772-667-7688
Mailing Address - Fax:603-952-3900
Practice Address - Street 1:16461 DOMESTIC AVENUE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-2899
Practice Address - Country:US
Practice Address - Phone:772-667-7688
Practice Address - Fax:603-952-3900
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7371207N00000X
FLOS17072207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61682Medicare UPIN
CAW18545Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER