Provider Demographics
NPI:1821104381
Name:STEWART, CARLYLE ANDERSON (MD)
Entity Type:Individual
Prefix:
First Name:CARLYLE
Middle Name:ANDERSON
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 1:6124 W PARKER RD STE 338
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8124
Mailing Address - Country:US
Mailing Address - Phone:972-981-7210
Mailing Address - Fax:972-981-7211
Practice Address - Street 1:6124 W PARKER RD STE 338
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8124
Practice Address - Country:US
Practice Address - Phone:972-981-7210
Practice Address - Fax:972-981-7211
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0985202-03Medicaid
TX8R1950OtherBCBS
TXC22277Medicare UPIN
TX8R1950OtherBCBS
TXP00187849Medicare PIN