Provider Demographics
NPI:1376694018
Name:STEWART, RICKY L (PA)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:L
Last Name:STEWART
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-2699
Mailing Address - Country:US
Mailing Address - Phone:561-748-2889
Mailing Address - Fax:561-748-1523
Practice Address - Street 1:18907 SE LOXAHATCHEE RIVER RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-1081
Practice Address - Country:US
Practice Address - Phone:561-748-2889
Practice Address - Fax:561-748-1523
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 3371363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical