Provider Demographics
NPI:1861588345
Name:STEWART, ROGER H (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:H
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6550 N FEDERAL HWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304
Mailing Address - Country:US
Mailing Address - Phone:954-491-0510
Mailing Address - Fax:954-491-0562
Practice Address - Street 1:6550 N FEDERAL HWY
Practice Address - Street 2:SUITE 320
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304
Practice Address - Country:US
Practice Address - Phone:954-491-0510
Practice Address - Fax:954-491-0562
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0023885207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51785Medicare UPIN
FL06930ZMedicare ID - Type Unspecified