MEDICARE: DR. GARRY LEROY STEWART M.D.

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	E3431	AR

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	:	1841293537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRY LEROY STEWART M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 11349
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-1349
Country	:	US
Telephone Number	:	501-513-1225
Fax Number	:	501-513-1228

Provider Business Practice Location Address
First Line	:	1545 HOGAN LANE
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-1349
Country	:	US
Telephone Number	:	501-513-1225
Fax Number	:	501-513-1228

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	01/15/2010

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