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General NPI Number Information
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NPI Number | 1942278452
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Entity Type | Individual
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Provider Name | JACK O. STEWART M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1310 W STEWART DR STE 408
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City | ORANGE
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State | CA
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Zip | 92868-3855
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Country | US
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Telephone | 714-639-9401
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Fax | 714-919-8807
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Provider Business Mailing Address
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Address Line | 1010 W LA VETA AVE STE 750
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City | ORANGE
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State | CA
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Zip | 92868-4312
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Country | US
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Telephone | 714-361-6600
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Fax | 714-919-8804
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | G48397
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License Number State | CA
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