Provider Demographics
NPI:1417966433
Name:STEWART, CLAY L (MD)
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:L
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1709
Mailing Address - Country:US
Mailing Address - Phone:806-350-3500
Mailing Address - Fax:806-359-3094
Practice Address - Street 1:7000 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1709
Practice Address - Country:US
Practice Address - Phone:806-350-3500
Practice Address - Fax:806-359-3094
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9429207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0016MTOtherBLUE CROSS
TX045693102Medicaid
E73502Medicare UPIN
TX009765Medicare PIN