Healthcare Provider Details

I. General information

NPI: 1750378675
Provider Name (Legal Business Name): LARRY PAUL STEWART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: L PAUL STEWART MD

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 N KINGSHIGHWAY BLVD SUITE 110
SAINT LOUIS MO
63113-1400
US

IV. Provider business mailing address

8 BROADVIEW FARM RD
SAINT LOUIS MO
63141-8501
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-8283
  • Fax:
Mailing address:
  • Phone: 314-576-4046
  • Fax: 314-576-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR6898
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: