MEDICARE: LARRY 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	207W00000X	Ophthalmology Physician	R6898	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750378675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY PAUL STEWART MD

Provider Business Mailing Address
First Line	:	8 BROADVIEW FARM RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8501
Country	:	US
Telephone Number	:	314-576-4046
Fax Number	:	314-576-4046

Provider Business Practice Location Address
First Line	:	1408 N KINGSHIGHWAY BLVD
Second Line	:	SUITE 110
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-1400
Country	:	US
Telephone Number	:	314-361-8283
Fax Number	:

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	01/27/2010

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