Healthcare Provider Details

I. General information

NPI: 1659334555
Provider Name (Legal Business Name): BRADLEY P STONER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKINGS DR BOX 1114
SAINT LOUIS MO
63130-4862
US

IV. Provider business mailing address

1 BROOKINGS DR BOX 1114
SAINT LOUIS MO
63130-4862
US

V. Phone/Fax

Practice location:
  • Phone: 314-935-5673
  • Fax: 314-935-8535
Mailing address:
  • Phone: 314-935-5673
  • Fax: 314-935-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number107369
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: