Provider Demographics
NPI:1811983026
Name:STEWART, RALPH W (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
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 1:501 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1024
Mailing Address - Country:US
Mailing Address - Phone:812-882-0555
Mailing Address - Fax:812-882-0720
Practice Address - Street 1:501 S 6TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1024
Practice Address - Country:US
Practice Address - Phone:812-882-0555
Practice Address - Fax:812-882-0720
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022355207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100154250AMedicaid
IN100154250AMedicaid
INC24984Medicare UPIN