Healthcare Provider Details

I. General information

NPI: 1457525933
Provider Name (Legal Business Name): GARRY STEWART MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 HOGAN LANE
CONWAY AR
72034-1349
US

IV. Provider business mailing address

P.O. BOX 11349
CONWAY AR
72034-1349
US

V. Phone/Fax

Practice location:
  • Phone: 501-513-1225
  • Fax: 501-513-1228
Mailing address:
  • Phone: 501-513-1225
  • Fax: 501-513-1228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3431
License Number StateAR

VIII. Authorized Official

Name: DR. GARRY STEWART
Title or Position: PRESIDENT
Credential: M.D.
Phone: 501-513-1225