Healthcare Provider Details

I. General information

NPI: 1144976473
Provider Name (Legal Business Name): STEWART PEDIATRIC ORTHOPEDIC OF NEVADA, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6462 LOSEE RD UNIT 900
NORTH LAS VEGAS NV
89086-0103
US

IV. Provider business mailing address

6462 LOSEE RD UNIT 900
NORTH LAS VEGAS NV
89086-0103
US

V. Phone/Fax

Practice location:
  • Phone: 702-701-2490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID GRANT STEWART JR.
Title or Position: OWNER
Credential: MD
Phone: 707-575-0155