=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396856308
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM MARC STUART M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 06/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1443 NE 8TH STREET
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33033-6567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-246-3864
-----------------------------------------------------
Fax | 863-771-5947
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1443 NE 8TH STREET
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33033-6567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-246-3864
-----------------------------------------------------
Fax | 863-771-5947
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 0062068
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------