Provider Demographics
NPI:1184608739
Name:STEWART, KIMBERLY D (DO)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:STEWART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9102 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1553
Mailing Address - Country:US
Mailing Address - Phone:210-616-9922
Mailing Address - Fax:512-597-0841
Practice Address - Street 1:4920 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1254
Practice Address - Country:US
Practice Address - Phone:936-569-9481
Practice Address - Fax:936-568-3400
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0169582085R0202X
TXM02842085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX488741YMJMMedicaid
TX178072805Medicare PIN
TX8F6531Medicare PIN
TX8AQ380OtherBCBS
TX178072802Medicaid
TXH86280Medicare UPIN