Provider Demographics
NPI:1003146689
Name:STEWARD, GARY BLAKE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:BLAKE
Last Name:STEWARD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 RUE BEAUX CHENES
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-7562
Mailing Address - Country:US
Mailing Address - Phone:228-273-7827
Mailing Address - Fax:
Practice Address - Street 1:2316 RUE BEAUX CHENES
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-7562
Practice Address - Country:US
Practice Address - Phone:228-273-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR854828367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered