Organization Name: | JORDAN R. STEWART, DPM, LLC |
NPI Number: | 1093731366 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JORDAN RICHARD STEWART (PODIATRIST/OWNER) |
Mailing Address: | 9622 Deereco Road Timonium |
State: | MD US |
Postal Code: | 21093 |
Phone Number: | 4105602777 |
Fax Number: | |
NPI Enumeration Date: | 07/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 01433 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |