Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 35083948 | OH |
NPI | 1265616650 |
---|---|
Provider Name | Gregory B Stewart |
First Address | Columbus, OH 43205-2664 |
Second Address | Delaware, OH 43015-7571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2007 |
Last Update Date | 14/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2820817 | (05) | OH |