Provider Demographics
NPI:1881883197
Name:THOMAS STEWART MD INC
Entity type:Organization
Organization Name:THOMAS STEWART MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-877-9925
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A306950174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A306950Medicaid
CAZZZ06325ZMedicare PIN
A26194Medicare PIN