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General NPI Number Information
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NPI Number | 1578548632
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Entity Type | Individual
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Provider Name | CHARLES S STEWART III MD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 1220 N HIGHWAY A1A SUITE 147
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City | INDIALANTIC
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State | FL
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Zip | 32903
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Country | US
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Telephone | 321-574-9061
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Fax | 321-951-9127
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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Country | US
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Telephone | 321-574-9061
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME53733
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License Number State | FL
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