Provider Demographics
NPI:1356510390
Name:EARL S. STEWART, M.D., P.A.
Entity Type:Organization
Organization Name:EARL S. STEWART, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-237-3232
Mailing Address - Street 1:4600 SW 46TH CT STE 330
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5755
Mailing Address - Country:US
Mailing Address - Phone:352-237-3232
Mailing Address - Fax:352-237-0167
Practice Address - Street 1:4600 SW 46TH CT STE 330
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5755
Practice Address - Country:US
Practice Address - Phone:352-237-3232
Practice Address - Fax:352-237-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91454OtherBCBS OF FL
FL91454OtherBCBS OF FL