Provider Demographics
NPI:1912966185
Name:STUART, KEVIN D (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:STUART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:D
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9460 NO NAME UNO
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020
Mailing Address - Country:US
Mailing Address - Phone:408-847-1311
Mailing Address - Fax:408-847-1322
Practice Address - Street 1:9460 NO NAME UNO
Practice Address - Street 2:SUITE 130
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-847-1311
Practice Address - Fax:408-847-1322
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71509207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE85489Medicare UPIN
CA00G715090Medicare ID - Type Unspecified