Healthcare Provider Details

I. General information

NPI: 1235195439
Provider Name (Legal Business Name): JOHN R STUART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

12127B HWY 14N SUITE 5
CEDAR CREST NM
87008-9499
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-1333
  • Fax: 505-990-3437
Mailing address:
  • Phone: 505-281-5180
  • Fax: 505-281-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2007-0459
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: