Provider Demographics
NPI:1225095383
Name:STONE, BRYAN LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LAWRENCE
Last Name:STONE
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 1:1180 N INDIAN CANYON DR
Mailing Address - Street 2:STE W303
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4800
Mailing Address - Country:US
Mailing Address - Phone:760-416-4819
Mailing Address - Fax:760-416-4829
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:STE W303
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-416-4819
Practice Address - Fax:760-416-4829
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG08187174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G801871Medicare PIN