Healthcare Provider Details

I. General information

NPI: 1326400557
Provider Name (Legal Business Name): COURTNEY STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 BUHNE ST STE A
EUREKA CA
95501-3205
US

IV. Provider business mailing address

2500 N BUFFALO DR STE 230
LAS VEGAS NV
89128-7856
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4593
  • Fax: 707-269-7116
Mailing address:
  • Phone: 702-710-4926
  • Fax: 844-724-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA151596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: