Healthcare Provider Details

I. General information

NPI: 1912966185
Provider Name (Legal Business Name): KEVIN D STUART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEVIN D STUART MD

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9460 NO NAME UNO SUITE 130
GILROY CA
95020
US

IV. Provider business mailing address

9460 NO NAME UNO SUITE 130
GILROY CA
95020
US

V. Phone/Fax

Practice location:
  • Phone: 408-847-1311
  • Fax: 408-847-1322
Mailing address:
  • Phone: 408-847-1311
  • Fax: 408-847-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG71509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: