Provider Demographics
NPI:1013016922
Name:STEWART, JOHN CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CRAIG
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 1:15252 PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-9558
Mailing Address - Country:US
Mailing Address - Phone:530-241-9078
Mailing Address - Fax:
Practice Address - Street 1:2175 ROSALINE AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-225-6000
Practice Address - Fax:530-243-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58227207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF58296Medicare UPIN