Provider Demographics
NPI:1669455952
Name:STEWART, TIMOTHY W (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 NW LAIDLAW RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-2562
Mailing Address - Country:US
Mailing Address - Phone:503-804-5845
Mailing Address - Fax:503-297-6590
Practice Address - Street 1:364 SE 8TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4249
Practice Address - Country:US
Practice Address - Phone:503-681-4145
Practice Address - Fax:503-681-4146
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14489207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR106585OtherMEDICARE PTAN
OR213660Medicaid
OR213660Medicaid