Provider Demographics
NPI:1578990206
Name:STEWART, NORMAN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:CHARLES
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 122585 DEPT 2585
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-480-5510
Mailing Address - Fax:337-480-5511
Practice Address - Street 1:1890 W GAUTHIER RD STE 135
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7179
Practice Address - Country:US
Practice Address - Phone:337-480-5510
Practice Address - Fax:337-480-5511
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272031207V00000X
OK32659207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2444212Medicaid
LAMD.305273OtherSTATE MEDICAL LICENSE