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General NPI Number Information
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NPI Number | 1063911683
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Entity Type | Organization
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Legal Business Name | LIVEUPMEDICAL PLLC
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Dates
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Enumeration Date | 02/09/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 205 N BONNIE BRAE ST
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City | DENTON
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State | TX
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Zip | 76201-3766
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Country | US
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Telephone | 940-384-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 S HULEN ST STE 124-558
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City | FT WORTH
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State | TX
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Zip | 76109-1929
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Country | US
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Telephone | 940-484-0914
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANE F STONE
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Credential | MD
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Telephone | 864-285-7227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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