Provider Demographics
NPI:1184623092
Name:STEWART, JEFFREY LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEE
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 1:1062 E RIVERSIDE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4454
Mailing Address - Country:US
Mailing Address - Phone:435-634-9225
Mailing Address - Fax:435-634-8426
Practice Address - Street 1:1062 E RIVERSIDE DR STE 102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4454
Practice Address - Country:US
Practice Address - Phone:435-634-9225
Practice Address - Fax:435-634-8426
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5285638-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00028353OtherRR MEDICARE
UT870545030SJLOtherEDUCATORS MUTUAL
UT52856380500001OtherBLUECROSS BLUE SHIELD
UT107019857101OtherINTERMOUNTAIN HEALTH CARE
NVV104751Medicare PIN
UT005729202Medicare ID - Type Unspecified
UTP00028353OtherRR MEDICARE
UT870545030SJLOtherEDUCATORS MUTUAL
UT000061231Medicare PIN
UT52856380500001OtherBLUECROSS BLUE SHIELD