Provider Demographics
NPI:1588717680
Name:STEWART, STEPHEN RAY (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RAY
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
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 311
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0311
Mailing Address - Country:US
Mailing Address - Phone:503-371-3512
Mailing Address - Fax:503-399-7467
Practice Address - Street 1:1600 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4122
Practice Address - Country:US
Practice Address - Phone:503-540-6400
Practice Address - Fax:503-399-7467
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10173207K00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR168997Medicaid
ORR0000BHKSNMedicare ID - Type Unspecified
ORA44841Medicare UPIN