MEDICARE: ANGELENE MARCELL STEWART D.O.

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	207R00000X	Internal Medicine Physician	K1077	TX

General Provider Information

NPI Number	:	1710923149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELENE MARCELL STEWART D.O.

Provider Business Mailing Address
First Line	:	7120 MCCART AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4200
Country	:	US
Telephone Number	:	817-294-5624
Fax Number	:	817-294-4711

Provider Business Practice Location Address
First Line	:	7120 MCCART AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4200
Country	:	US
Telephone Number	:	817-294-5624
Fax Number	:	817-294-4711

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	05/29/2012

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