Provider Demographics
NPI:1568504082
Name:STEWART, ROBERT L (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
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:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37644-0040
Mailing Address - Country:US
Mailing Address - Phone:423-542-2738
Mailing Address - Fax:423-542-2738
Practice Address - Street 1:922 WEST G STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643
Practice Address - Country:US
Practice Address - Phone:423-542-2738
Practice Address - Fax:423-542-2738
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD020176207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3044326OtherBLUE CROSS BLUE SHIELD
TN3073778Medicaid
TN3073778Medicare ID - Type Unspecified
E83038Medicare UPIN