Healthcare Provider Details

I. General information

NPI: 1538194121
Provider Name (Legal Business Name): SEAN M STONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE 92ND AVE
VANCOUVER WA
98664-3225
US

IV. Provider business mailing address

PO BOX 5037 UNIT 282
PORTLAND OR
97208-5037
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2142
  • Fax: 360-514-6820
Mailing address:
  • Phone: 360-514-2142
  • Fax: 360-514-6820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00048975
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number420010788
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: