Provider Demographics
NPI:1093010860
Name:KEVIN L STEWART, MD, PA
Entity Type:Organization
Organization Name:KEVIN L STEWART, MD, PA
Other - Org Name:LEGMAN VEIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-252-2120
Mailing Address - Street 1:812 W 8TH ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-7931
Mailing Address - Country:US
Mailing Address - Phone:806-291-8346
Mailing Address - Fax:806-291-8347
Practice Address - Street 1:812 W 8TH ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-7931
Practice Address - Country:US
Practice Address - Phone:806-291-8346
Practice Address - Fax:806-291-8347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty