Healthcare Provider Details

I. General information

NPI: 1326082231
Provider Name (Legal Business Name): REUBEN HARPER STONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 LAKELAND DR SUITE 61
JACKSON MS
39216-4635
US

IV. Provider business mailing address

970 LAKELAND DR STE 61
JACKSON MS
39216-4634
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-7850
  • Fax: 601-718-5145
Mailing address:
  • Phone: 601-982-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11428
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: