Provider Demographics
NPI:1679578660
Name:STEWART, KEVIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
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 1:305 RIVER FERN
Mailing Address - Street 2:APT 1425
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040
Mailing Address - Country:US
Mailing Address - Phone:806-224-3369
Mailing Address - Fax:
Practice Address - Street 1:305 RIVER FERN AVE APT 1425
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2404
Practice Address - Country:US
Practice Address - Phone:806-224-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2017-05-25
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXH5806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE07448Medicare UPIN
TX372656YSWXOtherMEDICARE INDIVIDUAL PTAN
TX372656ZJ8GOtherMEDICARE INDIVIDUAL PTAN
TXE07448Medicare UPIN
TXE07448Medicare UPIN
TX372656YUAVOtherMEDICARE INDIVIDUAL PTAN