Provider Demographics
NPI:1649371972
Name:STEWART, JEFFREY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8423 MARKET ST STE 207
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6778
Mailing Address - Country:US
Mailing Address - Phone:330-729-7901
Mailing Address - Fax:330-729-7915
Practice Address - Street 1:8423 MARKET ST STE 207
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6778
Practice Address - Country:US
Practice Address - Phone:330-729-7901
Practice Address - Fax:330-729-7915
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17135207VM0101X
WA60316121207VM0101X
MDD0073846207VM0101X
WI213-320207VM0101X
MEMD21154207VM0101X
OH35.138963207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100821640BMedicaid
OK100710160AMedicaid
OK100710160AMedicaid
OK100821640BMedicaid
OK417667OtherECFMG #
OKG32741Medicare UPIN