Healthcare Provider Details

I. General information

NPI: 1073995908
Provider Name (Legal Business Name): JOHN STONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 ELECTRIC RD
ROANOKE VA
24018-0720
US

IV. Provider business mailing address

PEDIATRIC RESIDENCY PROGRAM UK 800 ROSE ST MN472
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 540-769-0976
  • Fax: 540-857-5391
Mailing address:
  • Phone: 859-323-5157
  • Fax: 859-323-1315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR3874
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: