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NPI Code Detail

MEDICARE: FREDERICK E STEWART PA-C

MEDICARE: FREDERICK E STEWART PA-C
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
1363A00000XPhysician AssistantPA9108629FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA9108629OTHERFLFL PA LICENSE

General Provider Information

NPI Number : 1336262021
Entity Type Code : Individual
Provider Name (Legal Business Name) : FREDERICK E STEWART PA-C
Provider Business Mailing Address
First Line : 7955 SPYGLASS HILL RD STE A
Second Line :
City : MELBOURNE
State : FL
Zip : 32940-8249
Country : US
Telephone Number : 321-255-6670
Fax Number : 321-242-2545
Provider Business Practice Location Address
First Line : 7955 SPYGLASS HILL RD STE A
Second Line :
City : MELBOURNE
State : FL
Zip : 32940-8249
Country : US
Telephone Number : 321-255-6670
Fax Number : 321-242-2545
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 12/29/2015

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Directions to “ FREDERICK E STEWART PA-C” Practice Location

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