Healthcare Provider Details

I. General information

NPI: 1245268002
Provider Name (Legal Business Name): MARY L STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 DEBARR RD SUITE 300
ANCHORAGE AK
99508-2983
US

IV. Provider business mailing address

2925 DEBARR RD SUITE 300
ANCHORAGE AK
99508-2983
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-3155
  • Fax: 907-279-3154
Mailing address:
  • Phone: 907-279-3155
  • Fax: 907-279-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberAA2101
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: