Healthcare Provider Details

I. General information

NPI: 1922307693
Provider Name (Legal Business Name): LARISSA RENEE STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 04/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9303 PINECROFT DR STE 150
SPRING TX
77380-3183
US

IV. Provider business mailing address

6431 FANNIN STREET, SUITE JJL 310
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 281-363-5050
  • Fax: 281-363-5020
Mailing address:
  • Phone: 713-500-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberQ3294
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: