Provider Demographics
NPI:1831199009
Name:STEWART, THOMAS ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALLAN
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 1:6161 CLARK RD
Mailing Address - Street 2:STE 6
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4164
Mailing Address - Country:US
Mailing Address - Phone:530-877-9925
Mailing Address - Fax:530-877-7510
Practice Address - Street 1:6161 CLARK RD
Practice Address - Street 2:STE 6
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4164
Practice Address - Country:US
Practice Address - Phone:530-877-9925
Practice Address - Fax:530-877-7510
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A306950Medicaid
A23194Medicare UPIN
CAZZZ06325ZMedicare PIN