MEDICARE: DANIEL MAXWELL STUART 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	G48748	CA

General Provider Information

NPI Number	:	1326203605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MAXWELL STUART MD

Provider Business Mailing Address
First Line	:	PO BOX 181888
Second Line	:
City	:	CORONADO
State	:	CA
Zip	:	92178-1888
Country	:	US
Telephone Number	:	858-275-2206
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 EXECUTIVE DR STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3022
Country	:	US
Telephone Number	:	858-275-2206
Fax Number	:

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

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	02/04/2015

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