Provider Demographics
NPI:1619949146
Name:STEWART, JACQUELINE W (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:W
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 1:1621 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4703
Mailing Address - Country:US
Mailing Address - Phone:205-930-9500
Mailing Address - Fax:205-930-9503
Practice Address - Street 1:1621 11TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4703
Practice Address - Country:US
Practice Address - Phone:205-930-9500
Practice Address - Fax:205-930-9503
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC79120Medicare UPIN