Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G58227 | CA |
NPI | 1013016922 |
---|---|
Provider Name | John Craig Stewart |
First Address | Redding, CA 96001-9558 |
Second Address | Redding, CA 96001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 01/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F58296 | (02) | CA |