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General NPI Number Information
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NPI Number | 1932582111
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Entity Type | Organization
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Legal Business Name | STEWART DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 7000 BRYANT IRVIN RD
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City | FORT WORTH
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State | TX
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Zip | 76132-4250
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Country | US
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Telephone | 678-488-1673
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Fax |
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Provider Business Mailing Address
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Address Line | 3223 LEMMON AVE APT 2104
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City | DALLAS
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State | TX
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Zip | 75204-2359
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Country | US
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Telephone | 678-488-1673
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FAITH STEWART
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Credential | M.D.
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Telephone | 678-488-1673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | N9307
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License Number State | TX
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