Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G52842 | CA |
NPI | 1053317461 |
---|---|
Provider Name | Dr. Robert G Stewart |
First Address | San Luis Obispo, CA 93401-8724 |
Second Address | San Luis Obispo, CA 93401-8724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E47640 | (02) |