Provider Demographics
NPI:1083689244
Name:STEWART, DEBRA LEE (DO)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:STEWART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 34TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2307
Mailing Address - Country:US
Mailing Address - Phone:833-678-2781
Mailing Address - Fax:661-368-0618
Practice Address - Street 1:625 34TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2307
Practice Address - Country:US
Practice Address - Phone:833-678-2781
Practice Address - Fax:661-800-4318
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7174207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX71740Medicaid
CA00AX71740Medicaid