Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 17525 | OK |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 17525 | OK |
N | 207NS0135X | Procedural Dermatology | 17525 | OK |
NPI | 1457360646 |
---|---|
Provider Name | Dr. James Benton Stewart JR. |
First Address | Oklahoma City, OK 73134-1512 |
Second Address | Oklahoma City, OK 73134-1512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 09/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E69688 | (02) |