Provider Demographics
NPI:1619407475
Name:STEWART, ROBERT COLEMAN (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:COLEMAN
Last Name:STEWART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BRICKELL BAY DR APT 709
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2954
Mailing Address - Country:US
Mailing Address - Phone:435-668-1979
Mailing Address - Fax:
Practice Address - Street 1:5400 S UNIVERSITY DR STE 217
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5310
Practice Address - Country:US
Practice Address - Phone:954-900-2931
Practice Address - Fax:954-909-0174
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17492207Q00000X, 207R00000X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program