Provider Demographics
NPI:1689624033
Name:STEWART, JORDAN RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:RICHARD
Last Name:STEWART
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9622 DEERECO RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2120
Mailing Address - Country:US
Mailing Address - Phone:410-560-2777
Mailing Address - Fax:
Practice Address - Street 1:9622 DEERECO RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2120
Practice Address - Country:US
Practice Address - Phone:410-560-2777
Practice Address - Fax:443-901-1131
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01433213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery