Provider Demographics
NPI:1568497964
Name:DEEKENS, STEWART ANDREWS JR (MD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:ANDREWS
Last Name:DEEKENS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:730 MALCOLM BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671
Mailing Address - Country:US
Mailing Address - Phone:828-580-8684
Mailing Address - Fax:828-580-8439
Practice Address - Street 1:730 MALCOLM BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:RUTHERFORD COLLEGE
Practice Address - State:NC
Practice Address - Zip Code:28671
Practice Address - Country:US
Practice Address - Phone:828-580-8684
Practice Address - Fax:828-580-8439
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC25258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5798714OtherCIGNA OF NC
NC8928096Medicaid
NC013NJOtherBCBS
NC013NJOtherBCBS
NCC86288Medicare UPIN