Healthcare Provider Details

I. General information

NPI: 1043358336
Provider Name (Legal Business Name): HOLLY S. STEWART, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 9TH ST SUITE 360
LUBBOCK TX
79415-3300
US

IV. Provider business mailing address

3502 9TH ST SUITE 360
LUBBOCK TX
79415-3300
US

V. Phone/Fax

Practice location:
  • Phone: 806-744-7764
  • Fax: 806-744-7761
Mailing address:
  • Phone: 806-744-7764
  • Fax: 806-744-7761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberJ8790
License Number StateTX

VIII. Authorized Official

Name: HOLLY S STEWART
Title or Position: OWNER OPERATOR
Credential: M.D.
Phone: 806-744-7764