Basic Information
| Provider Information | |||||||||
| NPI: | 1124054986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1324 N HARVILLE RD | ||||||||
| Address2: | |||||||||
| City: | DUNCAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735331514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802521373 | ||||||||
| FaxNumber: | 5802528336 | ||||||||
| Practice Location | |||||||||
| Address1: | 1324 N HARVILLE RD | ||||||||
| Address2: | |||||||||
| City: | DUNCAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735331514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802521373 | ||||||||
| FaxNumber: | 5802528336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 05/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11715 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100726500B | 05 | OK | MEDICAID |