Healthcare Provider Details

I. General information

NPI: 1467539429
Provider Name (Legal Business Name): ROGER H STEWART MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/30/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 N FEDERAL HWY STE 320
FT LAUDERDALE FL
33308-1400
US

IV. Provider business mailing address

6550 N FEDERAL HWY STE 320
FT LAUDERDALE FL
33308-1400
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-0510
  • Fax: 954-491-0562
Mailing address:
  • Phone: 954-491-0510
  • Fax: 954-491-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0023885
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberSU14600
License Number StateFL

VIII. Authorized Official

Name: MRS. NICOLE KARTIKIS DAVIS
Title or Position: BILLING MANAGER
Credential:
Phone: 954-908-7534