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NPI Code Detail

MEDICARE: DEREK STEWART JR. MS

MEDICARE: DEREK STEWART JR. MS
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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11467745000OTHERLANPI

General Provider Information

NPI Number : 1720434293
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK STEWART JR. MS
Provider Business Mailing Address
First Line : 1614 E MAIN ST STE D
Second Line :
City : NEW IBERIA
State : LA
Zip : 70560-4056
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1614 E MAIN ST STE D
Second Line :
City : NEW IBERIA
State : LA
Zip : 70560-4056
Country : US
Telephone Number : 337-256-5917
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2016
Last Update Date : 02/03/2020

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