MACK D STEWART (NPI# 1902849417) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902849417 |
| Entity Type | Individual |
| Full Name | MACK D STEWART |
| Credential | MD |
| Practice Address |
107 Robert E Lee Dr Tyler TX 75703-4602 |
| Practice Telephone | 9035610300 |
| Mailing Telephone | 9035610300 |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2020-03-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | G8441 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TRICARE WINNSBORO LOCATION | TIN PLUS 044 | 01 |
| TX | TRICARE TYLER LOCATION | TIN PLUS 015 | 01 |
| TX | 137131207 | 05 | |
| TX | 137131211 | 05 | |
| TX | BCBS | 0077EJ | 01 |
| TX | 137131212 | 05 | |
| TX | TRICARE JV LOCATION | TIN PLUS 005 | 01 |
| Street Address |
107 ROBERT E LEE DR |
| City | TYLER |
| State | TX |
| Zip Code | 75703-4602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649735960 | Megan Victoria Augustus | Nurse Practitioner | 107 Robert E Lee Dr, Tyler, TX 75703-4602 | 2019-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1770052532 | Refinery Chiropractic LLC | Chiropractor | 16637 Old Jacksonville Hwy, Suite D, Tyler, TX 75703 | 2018-11-21 |
| 1215419353 | Deidre Lynn Fergason | Occupational Therapy Assistant | 3505 Old Jacksonville Hwy, Tyler, TX 75703 | 2018-09-05 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1083106462 | Integrity Health | Internal Medicine | 5605 Old Bullard Rd Ste B, Tyler, TX 75703 | 2018-06-01 |
| 1427572544 | Cody Wayne Graham | Pharmacist | 5415 S. Broadway Ave., Tyler, TX 75703 | 2017-07-31 |
| 1750805941 | Roger Bryan Chapman | Nurse Practitioner | 6115 New Copeland Rd, Tyler, TX 75703 | 2017-07-28 |
| 1427570084 | Darah Lynne Dahlem | Speech-Language Pathologist | 401 E. Front Street Ste 123, Tyler, TX 75703 | 2017-07-14 |
| 1194267468 | Herman Lester Hampton Jr. | Surgery | 5803 Regents Row, Tyler, TX 75703 | 2016-11-17 |
| Find all providers in zip 75703 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407140106 | Mark W Mcdonald | Emergency Medicine | 629 Winding Brook Ln, Tyler, TX 75703-0832 | 2011-05-31 |
| 1235260084 | Michael Byron Taylor | Emergency Medicine | 3102 Lakepine Cir, Tyler, TX 75707-1724 | 2007-03-07 |
| 1346279031 | Jill Marie Wortham | Emergency Medicine | 6210 S. Broadway, Tyler, TX 75703 | 2006-07-03 |
| 1699719872 | East Texas Medical Center Healthcare Associates | Emergency Medicine | 1000 S Beckham, Tyler, TX 75701 | 2006-06-16 |
| 1326082892 | East Texas Medical Center Healthcare Associates | Emergency Medicine | 6210 S Broadway Ave, Tyler, TX 75703-4413 | 2006-06-15 |
| 1760425326 | Bradley Robertson | Emergency Medicine | 1809 Capital Dr, Tyler, TX 75701-8438 | 2006-06-13 |
| 1295782977 | Sergio V Figueroa Jr. | Emergency Medicine | 1436 Hollytree Pl, Tyler, TX 75703-5774 | 2006-05-28 |
| 1144209354 | Paula Alinda Bessonett | Emergency Medicine | 222 E. Fifth Street, Tyler, TX 75701 | 2006-01-16 |
| 1871578989 | Evans Swann Smith | Emergency Medicine | 833 S Beckham Ave, Tyler, TX 75701-1905 | 2005-12-12 |
| 1831189836 | Joseph Pistone | Emergency Medicine | 5414 S Broadway Ave, Tyler, TX 75703-1335 | 2005-10-21 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.