Active NPI
Glen Stewart
- Clinical Pathology/Laboratory Medicine Physician
- Martinez, CA
National Provider Identifier
1417016742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Pathology/Laboratory Medicine Physician
- License
- G79035
- Practice address
- 2500 Alhambra Ave
Martinez, CA 94553-3156 - Phone
- (925) 370-5110
- Fax
- (925) 370-5145
- NPI assigned
- Dec 6, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Pathology/Laboratory Medicine Physician | 207ZP0105X | G79035 | CA | Primary |
Addresses
Primary practice location
2500 Alhambra Ave
Martinez, CA 94553-3156
Mailing address
50 Douglas Dr
Suite 391
Martinez, CA 94553-4098
Phone (925) 957-5429
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G79035 | CA | MD | Clinical Pathology/Laboratory Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417016742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 DOUGLAS DR",
"address_2": "SUITE 391",
"city": "MARTINEZ",
"state": "CA",
"postal_code": "945534098",
"telephone_number": "925-957-5429",
"fax_number": "925-957-5401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 ALHAMBRA AVE",
"city": "MARTINEZ",
"state": "CA",
"postal_code": "945533156",
"telephone_number": "925-370-5110",
"fax_number": "925-370-5145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEWART",
"first_name": "GLEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0105X",
"taxonomy_group": "",
"desc": "Pathology, Clinical Pathology/Laboratory Medicine",
"state": "CA",
"license": "G79035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinez, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.