Healthcare Provider Details

I. General information

NPI: 1457564064
Provider Name (Legal Business Name): RYAN A STEWART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BOULEVARD
DALLAS TX
75390-7208
US

IV. Provider business mailing address

P.O. BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3501
  • Fax: 214-645-0078
Mailing address:
  • Phone: 214-648-3501
  • Fax: 214-645-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM3398
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberM3398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: