Healthcare Provider Details

I. General information

NPI: 1720292139
Provider Name (Legal Business Name): CAMISA STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N HUDSON AVE
OKLAHOMA CITY OK
73103-3918
US

IV. Provider business mailing address

11720 WILEMAN WAY
OKLAHOMA CITY OK
73162-1843
US

V. Phone/Fax

Practice location:
  • Phone: 405-810-9578
  • Fax: 405-810-9597
Mailing address:
  • Phone: 405-826-1398
  • Fax: 405-810-9597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18469
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18469
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: