Provider Demographics
NPI:1528026812
Name:STEWART, GEOFFREY (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
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 1:1131 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1226
Mailing Address - Country:US
Mailing Address - Phone:407-849-1200
Mailing Address - Fax:407-841-7539
Practice Address - Street 1:1131 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1226
Practice Address - Country:US
Practice Address - Phone:407-849-1200
Practice Address - Fax:407-841-7539
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71059207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250065500Medicaid
FL31384Medicare ID - Type Unspecified
G10749Medicare UPIN