Provider Demographics
NPI:1871158345
Name:STEWART, RAYMOND POPE JR
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:POPE
Last Name:STEWART
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2243
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-2243
Mailing Address - Country:US
Mailing Address - Phone:575-527-5482
Mailing Address - Fax:575-652-4243
Practice Address - Street 1:9999 W. AMADOR AVENUE, STE. A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005
Practice Address - Country:US
Practice Address - Phone:575-527-5482
Practice Address - Fax:575-652-4243
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker