Provider Demographics
NPI:1568692853
Name:STEWART, LINZI LARUE (DO)
Entity Type:Individual
Prefix:DR
First Name:LINZI
Middle Name:LARUE
Last Name:STEWART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LINZI
Other - Middle Name:LARUE
Other - Last Name:STEWART-CRAWFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1100 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9104
Mailing Address - Country:US
Mailing Address - Phone:405-632-7256
Mailing Address - Fax:405-703-3804
Practice Address - Street 1:1100 SW 89TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9104
Practice Address - Country:US
Practice Address - Phone:405-632-7256
Practice Address - Fax:405-703-3804
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4813207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200253600AMedicaid
OK295671YS9UMedicare UPIN