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General NPI Number Information
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NPI Number | 1457525933
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Entity Type | Organization
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Legal Business Name | GARRY STEWART MD PA
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 1545 HOGAN LANE
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City | CONWAY
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State | AR
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Zip | 72034-1349
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Country | US
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Telephone | 501-513-1225
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Fax | 501-513-1228
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Provider Business Mailing Address
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Address Line | P.O. BOX 11349
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City | CONWAY
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State | AR
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Zip | 72034-1349
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Country | US
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Telephone | 501-513-1225
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Fax | 501-513-1228
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARRY STEWART
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Credential | M.D.
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Telephone | 501-513-1225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E3431
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License Number State | AR
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