Healthcare Provider Details

I. General information

NPI: 1295886711
Provider Name (Legal Business Name): MR. JAMES STEWART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12033 AGENCY RD
PARKER AZ
85344-7718
US

IV. Provider business mailing address

PO BOX 1016
PARKER AZ
85344-1016
US

V. Phone/Fax

Practice location:
  • Phone: 928-669-2137
  • Fax: 928-669-3131
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number279360
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: