Healthcare Provider Details

I. General information

NPI: 1942310388
Provider Name (Legal Business Name): DOUGLAS GREY STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 COLLEGE AVE
BERKELEY CA
94705-2755
US

IV. Provider business mailing address

3155 COLLEGE AVE
BERKELEY CA
94705-2755
US

V. Phone/Fax

Practice location:
  • Phone: 510-653-8014
  • Fax: 510-525-6139
Mailing address:
  • Phone: 510-653-8014
  • Fax: 510-525-6139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG11931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: