Provider Demographics
NPI:1497772412
Name:GRANT, STEWART A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:A
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:16765 FISHHAWK BLVD
Mailing Address - Street 2:314
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3860
Mailing Address - Country:US
Mailing Address - Phone:813-655-5106
Mailing Address - Fax:813-655-4460
Practice Address - Street 1:203 KINGSWAY RD
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4679
Practice Address - Country:US
Practice Address - Phone:813-655-5106
Practice Address - Fax:813-655-4460
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2011-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME72163208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL221083OtherWELLCARE
FL252632800Medicaid
FL41515OtherBCBS
FL268531100Medicaid
FL10392101OtherCITRUS
FL209902OtherAMERIGROUP
FL078366OtherAETNA
FL2321757005OtherCIGNA
FL132800OtherAETNA
DC7557019OtherAETNA