MEDICARE: DR. STEPHEN PAUL STEWART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2001022835	MO
2	207Q00000X	Family Medicine Physician	24275	IA

General Provider Information

NPI Number	:	1013152461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN PAUL STEWART MD

Provider Business Mailing Address
First Line	:	2265 BAGNELL DAM BLVD
Second Line	:	SIUTE 103
City	:	LAKE OZARK
State	:	MO
Zip	:	65049-8603
Country	:	US
Telephone Number	:	573-365-8800
Fax Number	:	573-365-6011

Provider Business Practice Location Address
First Line	:	2265 BAGNELL DAM BLVD
Second Line	:	SIUTE 103
City	:	LAKE OZARK
State	:	MO
Zip	:	65049-8603
Country	:	US
Telephone Number	:	573-365-8800
Fax Number	:	573-365-6011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	10/02/2012

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