Provider Demographics
NPI:1043213101
Name:SHONE, DALLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:
Last Name:SHONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:STE 4C
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3256
Practice Address - Country:US
Practice Address - Phone:423-578-1595
Practice Address - Fax:423-392-6624
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD25581207RG0100X
VA0101051162207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006011527Medicaid
TN1513713Medicaid
TN3084190Medicaid
VA6011527Medicaid
TN103I086169Medicare UPIN
F13414Medicare UPIN
VA006011527Medicaid
TNCC0450Medicare PIN
TN100009012Medicare PIN
TN0281780003Medicare PIN
TN0281780001Medicare PIN