Provider Demographics
NPI:1871592683
Name:STEWART, ROBERT JAMES (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
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 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-525-6485
Mailing Address - Fax:707-546-2188
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:STE 300
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3634
Practice Address - Country:US
Practice Address - Phone:707-546-2180
Practice Address - Fax:707-546-2188
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G305320Medicaid
CA00G305320OtherBLUE SHIELD OF CALIFORNIA
CA110081438OtherRAILROAD MEDICARE
CA110081438OtherRAILROAD MEDICARE
CA00G305320OtherBLUE SHIELD OF CALIFORNIA
CA00G305321Medicare PIN
CAA44453Medicare UPIN