Healthcare Provider Details

I. General information

NPI: 1982698544
Provider Name (Legal Business Name): ELIZABETH JEAN STONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 NW CULPEPPER TER
PORTLAND OR
97210-3121
US

IV. Provider business mailing address

646 NW CULPEPPER TER
PORTLAND OR
97210-3121
US

V. Phone/Fax

Practice location:
  • Phone: 503-243-2177
  • Fax: 503-241-2434
Mailing address:
  • Phone: 503-243-2177
  • Fax: 503-241-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number8334
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: