Healthcare Provider Details

I. General information

NPI: 1881622736
Provider Name (Legal Business Name): IRA MICHAEL STONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6170 A1A SOUTH UNIT 221
SAINT AUGUSTINE FL
32080
US

IV. Provider business mailing address

6170 A1A SOUTH UNIT 221
SAINT AUGUSTINE FL
32080
US

V. Phone/Fax

Practice location:
  • Phone: 904-471-2716
  • Fax: 352-873-9615
Mailing address:
  • Phone: 904-471-2716
  • Fax: 352-873-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME30440
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: