Healthcare Provider Details

I. General information

NPI: 1669455952
Provider Name (Legal Business Name): TIMOTHY W STEWART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 05/14/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 SE 8TH AVE STE 205
HILLSBORO OR
97123-4249
US

IV. Provider business mailing address

12215 NW LAIDLAW RD
PORTLAND OR
97229-2562
US

V. Phone/Fax

Practice location:
  • Phone: 503-681-4145
  • Fax: 503-681-4146
Mailing address:
  • Phone: 503-804-5845
  • Fax: 503-297-6590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD14489
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: