Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN 0010395 | FL |
NPI | 1033255534 |
---|---|
Provider Name | Dr. Michael Ian Stewart |
First Address | Palm Harbor, FL 34683-6274 |
Second Address | Clearwater, FL 33756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 25/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
072202200 | (05) | FL |