Healthcare Provider Details

I. General information

NPI: 1528393477
Provider Name (Legal Business Name): RICHARD T STONE, MD, FACS - A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST 407
PASADENA CA
91105-3045
US

IV. Provider business mailing address

10 CONGRESS ST 407
PASADENA CA
91105-3045
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-9941
  • Fax: 626-396-9586
Mailing address:
  • Phone: 626-396-9941
  • Fax: 626-396-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG29932
License Number StateCA

VIII. Authorized Official

Name: RICHARD THOMAS STONE
Title or Position: PRESIDENT
Credential: MD
Phone: 626-396-9941