Provider Demographics
NPI:1275621823
Name:STONE, W KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:KENNETH
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2656 EDITH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3030
Mailing Address - Country:US
Mailing Address - Phone:530-244-2882
Mailing Address - Fax:530-244-3703
Practice Address - Street 1:2656 EDITH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3030
Practice Address - Country:US
Practice Address - Phone:530-244-2882
Practice Address - Fax:530-244-3703
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA36413208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C369420Medicaid
CA00C369420Medicaid
CAA36413Medicare UPIN