Provider Demographics
NPI:1578625844
Name:STEWART, LINDA C (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 CHEVELLE CT STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6502
Mailing Address - Country:US
Mailing Address - Phone:225-926-1495
Mailing Address - Fax:
Practice Address - Street 1:604 CHEVELLE CT STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6502
Practice Address - Country:US
Practice Address - Phone:225-926-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1126128Medicaid
LAC67718Medicare UPIN
LA1126128Medicaid