Healthcare Provider Details

I. General information

NPI: 1174589030
Provider Name (Legal Business Name): VICTOR STONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: YOSHIHIDE ISHII M.D.

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 GOVERNORS DR APT 2624
PENSACOLA FL
32514-9442
US

IV. Provider business mailing address

1602 GOVERNORS DR APT 2624
PENSACOLA FL
32514-9442
US

V. Phone/Fax

Practice location:
  • Phone: 215-805-6629
  • Fax:
Mailing address:
  • Phone: 215-805-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101239092
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: