Provider Demographics
NPI:1609154657
Name:STEWART, WALTER STEPHEN (DPH)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:STEPHEN
Last Name:STEWART
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1960
Mailing Address - Country:US
Mailing Address - Phone:865-675-8180
Mailing Address - Fax:865-675-8180
Practice Address - Street 1:11100 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1960
Practice Address - Country:US
Practice Address - Phone:865-675-8180
Practice Address - Fax:865-675-8180
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist