Provider Demographics
NPI:1376042879
Name:GREGORY D. STEWART
Entity Type:Organization
Organization Name:GREGORY D. STEWART
Other - Org Name:STEWART SURGICAL ASSISTANT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:206-948-4671
Mailing Address - Street 1:PO BOX 1542
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-7742
Mailing Address - Country:US
Mailing Address - Phone:206-948-4671
Mailing Address - Fax:425-513-9456
Practice Address - Street 1:747 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4379
Practice Address - Country:US
Practice Address - Phone:206-948-4671
Practice Address - Fax:425-513-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA0002153363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty