Basic Information
| Provider Information | |||||||||
| NPI: | 1568427573 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | GARNER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 LANDERS RD | ||||||||
| Address2: | SUITE I | ||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721172525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017711600 | ||||||||
| FaxNumber: | 5019552252 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 SAINT VINCENT CIR | ||||||||
| Address2: | #100 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722055412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016636455 | ||||||||
| FaxNumber: | 5012274838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 12/01/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | E2271 | AR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | E2271 | AR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 139021001 | 05 | AR | MEDICAID |