Provider Demographics
NPI:1346216611
Name:STEWART, GREGORY S (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W YELLOWSTONE AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8702
Mailing Address - Country:US
Mailing Address - Phone:307-587-5131
Mailing Address - Fax:307-587-5132
Practice Address - Street 1:225 W YELLOWSTONE AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8702
Practice Address - Country:US
Practice Address - Phone:307-587-5131
Practice Address - Fax:307-587-5132
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY7308A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314014OtherBLUE CROSS BLUE SHIELD
WY122121300Medicaid
WY122121300Medicaid
WY314014OtherBLUE CROSS BLUE SHIELD