MEDICARE: JOHN STEWART PSY.D. PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	941	OK

General Provider Information

NPI Number	:	1578557849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN STEWART PSY.D. PC

Provider Business Mailing Address
First Line	:	1009 22ND ST
Second Line	:
City	:	WOODWARD
State	:	OK
Zip	:	73801-2824
Country	:	US
Telephone Number	:	580-256-6009
Fax Number	:	866-895-5991

Provider Business Practice Location Address
First Line	:	1009 22ND ST
Second Line	:
City	:	WOODWARD
State	:	OK
Zip	:	73801-2824
Country	:	US
Telephone Number	:	580-256-6009
Fax Number	:	866-895-5991

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN BENTON STEWART II
Credential	:	PSY.D.
Telephone Number	:	580-256-6009

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	08/22/2020

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