Provider Demographics
NPI:1356389696
Name:STEWART, DENIS W (MD)
Entity type:Individual
Prefix:
First Name:DENIS
Middle Name:W
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:PO BOX 1175
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34656-1175
Mailing Address - Country:US
Mailing Address - Phone:727-841-8225
Mailing Address - Fax:727-846-8549
Practice Address - Street 1:5539 MARINE PKWY
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4329
Practice Address - Country:US
Practice Address - Phone:727-841-8225
Practice Address - Fax:724-846-8549
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0063242174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300074143OtherRR MEDICARE
FL379616700Medicaid
FL28901Medicare ID - Type Unspecified
FL379616700Medicaid