Provider Demographics
NPI:1972651214
Name:STEWART, DESHAWN K (MD)
Entity type:Individual
Prefix:DR
First Name:DESHAWN
Middle Name:K
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 1:4118 CANDLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4442
Mailing Address - Country:US
Mailing Address - Phone:940-923-1786
Mailing Address - Fax:
Practice Address - Street 1:4118 CANDLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4442
Practice Address - Country:US
Practice Address - Phone:940-923-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5007207P00000X, 207Q00000X
KS04-30305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319924201Medicaid
TXP01311907OtherRAILROAD MEDICARE
TX319924201Medicaid