Provider Demographics
NPI:1518911676
Name:STEWART, MARIAN W (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:W
Last Name:STEWART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8781
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-8781
Mailing Address - Country:US
Mailing Address - Phone:417-339-5691
Mailing Address - Fax:417-339-7335
Practice Address - Street 1:10994 HISTORIC HIGHWAY 165 STE D
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-5606
Practice Address - Country:US
Practice Address - Phone:417-239-0079
Practice Address - Fax:417-239-1228
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1016442086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431835078OtherTRICARE
MO21186039OtherBLUE SHIELD OF KC
MO244744504Medicaid
MOP00204814OtherRAILROAD MEDICARE
MO244744504Medicaid