Provider Demographics
NPI:1639723943
Name:STEWART, PETER W
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 ANCHOR WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4692
Mailing Address - Country:US
Mailing Address - Phone:340-719-7564
Mailing Address - Fax:340-719-7566
Practice Address - Street 1:2D ESTATE PRINCESS
Practice Address - Street 2:ABC BUILDING
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:405-623-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator