Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301093528 | MI |
N | 207X00000X | Orthopaedic Surgeon | M9678 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 4301093528 | MI |
NPI | 1073768917 |
---|---|
Provider Name | Dr. Bruce Andrew Stewart |
First Address | Holland, MI 49424-2196 |
Second Address | Holland, MI 49424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2008 |
Last Update Date | 30/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073768917 | (05) | MI |
BS093528 | BLUE CROSS BLUE SHIELD (01) |