Provider Demographics
NPI:1447220926
Name:STEWART, JOHN S (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:STEWART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9377 E BELL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1504
Mailing Address - Country:US
Mailing Address - Phone:480-306-3739
Mailing Address - Fax:480-550-6248
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:STE 207
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1504
Practice Address - Country:US
Practice Address - Phone:805-210-5491
Practice Address - Fax:805-842-2648
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18626207Y00000X, 207YX0905X
AZ008415207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05909019Medicaid
MS287289OtherMEDICARE- OTHER UNSPECIFIED
MS05909019Medicaid