Healthcare Provider Details

I. General information

NPI: 1790824647
Provider Name (Legal Business Name): JEFFERY DEAN STUART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 E CAMP LOWELL DR
TUCSON AZ
85712-1256
US

IV. Provider business mailing address

3361 N ELENA MARIA
TUCSON AZ
85750-2919
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-8700
  • Fax: 520-795-8850
Mailing address:
  • Phone: 520-722-4907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number14881
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: