Healthcare Provider Details

I. General information

NPI: 1275621823
Provider Name (Legal Business Name): W KENNETH STONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 EDITH AVE SUITE B
REDDING CA
96001-3030
US

IV. Provider business mailing address

2656 EDITH AVE SUITE B
REDDING CA
96001-3030
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-2882
  • Fax: 530-244-3703
Mailing address:
  • Phone: 530-244-2882
  • Fax: 530-244-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA36413
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA36413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: