Provider Demographics
NPI:1922307693
Name:STEWART, LARISSA RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:RENEE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN STREET, SUITE JJL 310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-5151
Mailing Address - Fax:
Practice Address - Street 1:9303 PINECROFT DR STE 150
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3183
Practice Address - Country:US
Practice Address - Phone:281-363-5050
Practice Address - Fax:281-363-5020
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3294207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology