Provider Demographics
NPI:1952987786
Name:STEWART, JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JACOB
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:716 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2346
Mailing Address - Country:US
Mailing Address - Phone:618-294-8241
Mailing Address - Fax:618-294-8212
Practice Address - Street 1:716 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2346
Practice Address - Country:US
Practice Address - Phone:618-294-8241
Practice Address - Fax:186-294-8212
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036167070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine