Healthcare Provider Details

I. General information

NPI: 1598776866
Provider Name (Legal Business Name): JAMES B. STEWART, JR., M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 W MEMORIAL RD SUITE 101
OKLAHOMA CITY OK
73134-1512
US

IV. Provider business mailing address

3705 W MEMORIAL RD SUITE 101
OKLAHOMA CITY OK
73134-1512
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-0020
  • Fax: 405-751-0009
Mailing address:
  • Phone: 405-751-0020
  • Fax: 405-751-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number17525
License Number StateOK

VIII. Authorized Official

Name: DR. JAMES BENTON STEWART JR.
Title or Position: PRESIDENT
Credential: M.D., P.C.
Phone: 405-751-0020