Basic Information
| Provider Information | |||||||||
| NPI: | 1730118159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 82396 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933802396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613235918 | ||||||||
| FaxNumber: | 6613234703 | ||||||||
| Practice Location | |||||||||
| Address1: | 2615 EYE ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933012006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613953000 | ||||||||
| FaxNumber: | 6613234703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/18/2009 | ||||||||
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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 | G7343 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000G73430 | 05 | CA | MEDICAID | BV786Y | 01 | CA | WSUC MEDICARE PTAN | OTHER | BV786Z | 01 | CA | SJCH RENEWED MEDICARE PTAN | OTHER |