Provider Demographics
NPI:1548524093
Name:STEWART, TARA DEANN (DO)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:DEANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:DEANN
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:14025 N EASTERN AVE
Mailing Address - Street 2:APT 1101
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5588
Mailing Address - Country:US
Mailing Address - Phone:405-830-2006
Mailing Address - Fax:
Practice Address - Street 1:4401 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3413
Practice Address - Country:US
Practice Address - Phone:405-830-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5252207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine