Healthcare Provider Details

I. General information

NPI: 1447879366
Provider Name (Legal Business Name): THOMAS STEWART DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 12/29/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 AUSTIN RD
STOCKTON CA
95215-8312
US

IV. Provider business mailing address

7707 AUSTIN RD
STOCKTON CA
95215-8312
US

V. Phone/Fax

Practice location:
  • Phone: 209-467-2500
  • Fax:
Mailing address:
  • Phone: 209-467-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A22340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: