Provider Demographics
NPI:1841293537
Name:STEWART, GARRY LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:LEROY
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:P.O. BOX 11349
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-1349
Mailing Address - Country:US
Mailing Address - Phone:501-513-1225
Mailing Address - Fax:501-513-1228
Practice Address - Street 1:1545 HOGAN LANE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-1349
Practice Address - Country:US
Practice Address - Phone:501-513-1225
Practice Address - Fax:501-513-1228
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148117001Medicaid
H62938Medicare UPIN
AR148117001Medicaid