Healthcare Provider Details

I. General information

NPI: 1376694018
Provider Name (Legal Business Name): RICKY L STEWART P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18907 SE LOXAHATCHEE RIVER RD
JUPITER FL
33458-1081
US

IV. Provider business mailing address

PO BOX 2699
JUPITER FL
33468-2699
US

V. Phone/Fax

Practice location:
  • Phone: 561-748-2889
  • Fax: 561-748-1523
Mailing address:
  • Phone: 561-748-2889
  • Fax: 561-748-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 3371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: