Provider Demographics
NPI:1265423313
Name:STEWART, JOHN ALVIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALVIN
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:122 N 20TH ST
Mailing Address - Street 2:BLDG 25
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5442
Mailing Address - Country:US
Mailing Address - Phone:334-749-5604
Mailing Address - Fax:334-749-3040
Practice Address - Street 1:122 N 20TH ST
Practice Address - Street 2:BLDG 25
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5442
Practice Address - Country:US
Practice Address - Phone:334-749-5604
Practice Address - Fax:334-749-3040
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00009216207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-06042OtherBLUE CROSS BLUE SHIELD
AL510-06042OtherBLUE CROSS BLUE SHIELD
C71902Medicare UPIN
AL000006042Medicaid