Healthcare Provider Details

I. General information

NPI: 1972565109
Provider Name (Legal Business Name): TONI CYD STOCKTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16611 S. 40TH STREET SUITE 100
PHOENIX AZ
85048
US

IV. Provider business mailing address

16611 S. 40TH STREET SUITE 100
PHOENIX AZ
85048
US

V. Phone/Fax

Practice location:
  • Phone: 480-610-6366
  • Fax: 480-833-1653
Mailing address:
  • Phone: 480-610-6366
  • Fax: 480-833-1653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number22013
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: