Provider Demographics
NPI:1912195561
Name:KEVIN D STUART, M.D A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KEVIN D STUART, M.D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-847-1311
Mailing Address - Street 1:9460 N NAME UNO STE 130
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3532
Mailing Address - Country:US
Mailing Address - Phone:408-847-1311
Mailing Address - Fax:408-847-1322
Practice Address - Street 1:9460 N NAME UNO STE 130
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3532
Practice Address - Country:US
Practice Address - Phone:408-847-1311
Practice Address - Fax:408-847-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71509207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28058ZMedicare PIN