Provider Demographics
NPI:1588664809
Name:STEWART, MARTHA J (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
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 1:4800 LA JOLLA
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7847
Mailing Address - Country:US
Mailing Address - Phone:850-549-5491
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-7847
Practice Address - Country:US
Practice Address - Phone:608-263-1530
Practice Address - Fax:608-265-8887
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101190-875207RC0000X
FLME92289207RC0000X
WI21554-875207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009982475Medicaid
FL2717034 00Medicaid
FL64256ZMedicare PIN
FLA13769Medicare UPIN
AL009982475Medicaid