Provider Demographics
NPI:1538135512
Name:STEWART, JOHN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARTIN
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 1:8020 CONSTITUTION PLACE NE
Mailing Address - Street 2:#202
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-998-3096
Mailing Address - Fax:505-998-3100
Practice Address - Street 1:8020 CONSTITUTION PLACE NE
Practice Address - Street 2:#101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-998-1317
Practice Address - Fax:505-998-1308
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD200506322085R0202X
NMMD2005-06322085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95002839Medicaid
AZ974586Medicaid
AZ974586Medicaid
81R995Medicare ID - Type Unspecified