MEDICARE: DR. IRA MICHAEL STONE M.D.

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	207RC0000X	Cardiovascular Disease Physician	ME30440	FL

General Provider Information

NPI Number	:	1881622736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA MICHAEL STONE M.D.

Provider Business Mailing Address
First Line	:	6170 A1A SOUTH
Second Line	:	UNIT 221
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080
Country	:	US
Telephone Number	:	904-471-2716
Fax Number	:	352-873-9615

Provider Business Practice Location Address
First Line	:	6170 A1A SOUTH
Second Line	:	UNIT 221
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080
Country	:	US
Telephone Number	:	904-471-2716
Fax Number	:	352-873-9615

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	11/30/2018

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