Provider Demographics
NPI:1629236575
Name:STUART, SELENA JUAREZ (MD)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:JUAREZ
Last Name:STUART
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:1448 E COMMON ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3162
Practice Address - Country:US
Practice Address - Phone:830-643-1762
Practice Address - Fax:830-609-7702
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30115207R00000X
TXQ5289207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358200903Medicaid
AL128581Medicaid
AL051116308OtherBCBS
AL051116310OtherBCBS
MS04576241Medicaid
AL128506Medicaid
AL128584Medicaid
AL051116309OtherBCBS