Provider Demographics
NPI:1598776866
Name:JAMES B. STEWART, JR., M.D., P.C.
Entity Type:Organization
Organization Name:JAMES B. STEWART, JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BENTON
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:405-751-0020
Mailing Address - Street 1:3705 W MEMORIAL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1512
Mailing Address - Country:US
Mailing Address - Phone:405-751-0020
Mailing Address - Fax:405-751-0009
Practice Address - Street 1:3705 W MEMORIAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1512
Practice Address - Country:US
Practice Address - Phone:405-751-0020
Practice Address - Fax:405-751-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17525207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE69688Medicare UPIN