Provider Demographics
NPI:1629065834
Name:REID, STEWART ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:ROSS
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10830 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-1050
Mailing Address - Country:US
Mailing Address - Phone:214-696-3540
Mailing Address - Fax:214-696-1230
Practice Address - Street 1:10830 N CENTRAL EXPY
Practice Address - Street 2:SUITE 330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1050
Practice Address - Country:US
Practice Address - Phone:214-696-3540
Practice Address - Fax:214-696-1230
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1024207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000K09C0Medicaid
TX00K093Medicare ID - Type Unspecified
TXF46717Medicare UPIN