Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 03339 | KY |
N | 207P00000X | Emergency Physician | 34008638 | OH |
NPI | 1003010539 |
---|---|
Provider Name | Dr. Richard Stewart |
First Address | Erlanger, KY 41018-0667 |
Second Address | Fort Thomas, KY 41075-1793 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 07/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000291736 | BCBS (01) | OH |
201047710 | (05) | IN |
2774798 | (05) | OH |
7100182240 | (05) | KY |
I74144 | (02) | OH |