Provider Demographics
NPI:1093897449
Name:STONE, MARY E (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:STONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 DENVER TRL
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3614
Mailing Address - Country:US
Mailing Address - Phone:817-820-4906
Mailing Address - Fax:817-820-4815
Practice Address - Street 1:108 DENVER TRL
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3614
Practice Address - Country:US
Practice Address - Phone:817-820-4906
Practice Address - Fax:817-820-4815
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038205302Medicaid
TX8B2957OtherBLUE CROSS & BLUE SHIEDL
TX930109733OtherRAIL ROAD MEDICARE
TX038205302Medicaid
TX930109733OtherRAIL ROAD MEDICARE