MEDICARE: MR. JOHN STONEMAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA10003768	WA
2	363A00000X	Physician Assistant	91790	MT
3	363AS0400X	Surgical Physician Assistant	PA10003768	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	382941	OTHER	WA	LNI

General Provider Information

NPI Number	:	1356380836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN STONEMAN PA-C

Provider Business Mailing Address
First Line	:	550 GAGE BLVD STE 101
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-9532
Country	:	US
Telephone Number	:	509-942-3627
Fax Number	:	509-627-2983

Provider Business Practice Location Address
First Line	:	1100 GOETHALS DR STE E
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-3301
Country	:	US
Telephone Number	:	509-942-3095
Fax Number	:	509-942-3097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	11/07/2022

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Directions to “ MR. JOHN STONEMAN PA-C” Practice Location

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