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General NPI Number Information
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NPI Number | 1528192127
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Entity Type | Individual
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Provider Name | THOMAS J STEWART PA
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 204 E 19TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-4707
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Country | US
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Telephone | 850-784-2105
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Fax | 850-522-9453
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Provider Business Mailing Address
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Address Line | 204 E 19TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-4707
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Country | US
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Telephone | 850-784-2105
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Fax | 850-522-9453
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | FLPA0001600
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License Number State | FL
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