Provider Demographics
NPI:1477973105
Name:STEWART, CHRISTOPHER NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:NICHOLAS
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 1:218 E 7TH ST UNIT 202
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3161
Mailing Address - Country:US
Mailing Address - Phone:608-359-6478
Mailing Address - Fax:
Practice Address - Street 1:204 S DURBIN ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2562
Practice Address - Country:US
Practice Address - Phone:307-234-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14867A2086S0122X
ORMD1975642086S0122X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program