1811903917 NPI number — DR. RICHARD LIONEL STEWART JR. PH.D.

Table of content: DR. RICHARD LIONEL STEWART JR. PH.D. (NPI 1811903917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811903917 NPI number — DR. RICHARD LIONEL STEWART JR. PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
RICHARD
Provider Middle Name:
LIONEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811903917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
272 FAIRWAY ISLES LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34212-9325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-748-4739
Provider Business Mailing Address Fax Number:
941-747-6267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
677 N WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34236-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-747-6267
Provider Business Practice Location Address Fax Number:
941-747-6267
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY0005669 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TF0200X , with the licence number: PY0005669 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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