Provider Demographics
NPI:1558576371
Name:STEWART, THOMAS ALLAN JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALLAN
Last Name:STEWART
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 MISSION RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2175
Mailing Address - Country:US
Mailing Address - Phone:530-342-2411
Mailing Address - Fax:530-894-5783
Practice Address - Street 1:135 MISSION RANCH BLVD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2175
Practice Address - Country:US
Practice Address - Phone:530-342-2411
Practice Address - Fax:530-894-5783
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA97950207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558576371Medicaid