Provider Demographics
NPI:1508965518
Name:STEWART, BERT MONTGOMERY (MD)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:MONTGOMERY
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 1:1801 HIGHWAY 99 N
Mailing Address - Street 2:STE 2
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9152
Mailing Address - Country:US
Mailing Address - Phone:541-488-4464
Mailing Address - Fax:541-488-3772
Practice Address - Street 1:1801 HIGHWAY 99 N
Practice Address - Street 2:STE 2
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9152
Practice Address - Country:US
Practice Address - Phone:541-488-4464
Practice Address - Fax:541-488-3772
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23395208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR112156Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
F60882Medicare UPIN