Healthcare Provider Details

I. General information

NPI: 1750335055
Provider Name (Legal Business Name): WILLIAM MASON BONE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2846 WALLACE LAKE RD
PACE FL
32571
US

IV. Provider business mailing address

340 ASBURY AVE
RIPLEY TN
38063-5577
US

V. Phone/Fax

Practice location:
  • Phone: 850-995-7273
  • Fax: 347-214-8207
Mailing address:
  • Phone: 660-826-8833
  • Fax: 660-829-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37548
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number30285
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45517
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2001007179
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number01049225A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 97720
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36565
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37548
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: