Provider Demographics
NPI:1043358336
Name:HOLLY S. STEWART, MD PA
Entity Type:Organization
Organization Name:HOLLY S. STEWART, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-744-7764
Mailing Address - Street 1:3502 9TH ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-3300
Mailing Address - Country:US
Mailing Address - Phone:806-744-7764
Mailing Address - Fax:806-744-7761
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:SUITE 360
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-744-7764
Practice Address - Fax:806-744-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8790261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ8790OtherSTATE MEDICAL LICENSE
TXJ8790OtherSTATE MEDICAL LICENSE