Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | L7894 | TX |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | L7894 | TX |
NPI | 1003859901 |
---|---|
Provider Name | Dr. Theresa Lynn Stewart |
First Address | Dallas, TX 75284-6098 |
Second Address | San Antonio, TX 78236-5638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 11/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
175497012 | (05) | TX |
8LP974 | BCBS (01) | TX |