Provider Demographics
NPI:1790824647
Name:STUART, JEFFERY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DEAN
Last Name:STUART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3361 N ELENA MARIA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-2919
Mailing Address - Country:US
Mailing Address - Phone:520-722-4907
Mailing Address - Fax:
Practice Address - Street 1:4721 E CAMP LOWELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1256
Practice Address - Country:US
Practice Address - Phone:520-795-8700
Practice Address - Fax:520-795-8850
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ14881208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE24079Medicare UPIN