Provider Demographics
NPI:1841262003
Name:STEWART, RANDY L (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:L
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 1:201 S. PARK ST.
Mailing Address - Street 2:PO BOX 130
Mailing Address - City:CLAUDE
Mailing Address - State:TX
Mailing Address - Zip Code:79019-0130
Mailing Address - Country:US
Mailing Address - Phone:806-226-5611
Mailing Address - Fax:806-226-6703
Practice Address - Street 1:201 S. PARK ST.
Practice Address - Street 2:
Practice Address - City:CLAUDE
Practice Address - State:TX
Practice Address - Zip Code:79019-0130
Practice Address - Country:US
Practice Address - Phone:806-226-5611
Practice Address - Fax:806-226-6703
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063682101Medicaid
TX1371858015Medicaid
NM000X9521Medicaid
OK100179660 AMedicaid
TX673819Medicare ID - Type UnspecifiedMEDICARE ID #
OK100179660 AMedicaid
TX063682101Medicaid