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General NPI Number Information
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NPI Number | 1912195561
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Entity Type | Organization
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Legal Business Name | KEVIN D STUART, M.D A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 9460 N NAME UNO STE 130
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City | GILROY
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State | CA
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Zip | 95020-3532
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Country | US
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Telephone | 408-847-1311
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Fax | 408-847-1322
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Provider Business Mailing Address
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Address Line | 9460 N NAME UNO STE 130
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City | GILROY
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State | CA
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Zip | 95020-3532
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Country | US
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Telephone | 408-847-1311
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Fax | 408-847-1322
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | DR. KEVIN D STUART
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Credential | M.D
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Telephone | 408-847-1311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G71509
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License Number State | CA
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