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General NPI Number Information
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NPI Number | 1912126293
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Entity Type | Individual
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Provider Name | GRACE ELMA STEWART M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5850 E STILL CIR
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City | MESA
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State | AZ
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Zip | 85206-3618
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Country | US
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Telephone | 480-219-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 315 W EL CAMINO DR
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City | PHOENIX
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State | AZ
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Zip | 85021-5524
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Country | US
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Telephone | 602-943-9657
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | AZ15608
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License Number State | AZ
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