Provider Demographics
NPI:1477535136
Name:STONE, ROSS G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:G
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 1:120 JFK DR
Mailing Address - Street 2:SUITE 124
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6623
Mailing Address - Country:US
Mailing Address - Phone:561-965-5700
Mailing Address - Fax:561-965-8003
Practice Address - Street 1:120 JFK DR
Practice Address - Street 2:SUITE 124
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6623
Practice Address - Country:US
Practice Address - Phone:561-965-5700
Practice Address - Fax:561-965-8003
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006622800Medicaid
61313OtherBC/BS
FLD57188Medicare UPIN