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General NPI Number Information
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NPI Number | 1629384920
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Entity Type | Organization
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Legal Business Name | MARTIN SPENCER STONE MD PA
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 10139 NW 31ST ST SUITE103
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-3908
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Country | US
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Telephone | 954-755-0350
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Fax | 866-480-1605
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Provider Business Mailing Address
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Address Line | 10139 NW 31ST ST SUITE103
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-3908
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Country | US
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Telephone | 954-755-0350
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Fax | 866-480-1605
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MARTIN SPENCER STONE
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Credential | MD
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Telephone | 954-755-0350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0033411
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License Number State | FL
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 106518200
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer | Florida Medicaid Provider ID
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