Provider Demographics
NPI:1649273939
Name:STEWART, ROBERT SCOTT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
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 1:3204 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1743
Mailing Address - Country:US
Mailing Address - Phone:405-878-6800
Mailing Address - Fax:405-878-6831
Practice Address - Street 1:3204 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-5014
Practice Address - Country:US
Practice Address - Phone:405-878-6800
Practice Address - Fax:405-878-6831
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0302664002OtherCIGNA
OK100118700BMedicaid
OP0330008OtherHUMANA
89417OtherAETNA
80156052OtherUNITED HEALTHCARE
OK100118700BMedicaid
G33023Medicare UPIN