Provider Demographics
NPI:1487673315
Name:STONE, LANNY MICHAEL (PA)
Entity Type:Individual
Prefix:MR
First Name:LANNY
Middle Name:MICHAEL
Last Name:STONE
Suffix:
Gender:M
Credentials:PA
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 1219
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7219
Mailing Address - Country:US
Mailing Address - Phone:512-355-9233
Mailing Address - Fax:512-355-9230
Practice Address - Street 1:160 N LAMPASAS
Practice Address - Street 2:
Practice Address - City:BERTRAM
Practice Address - State:TX
Practice Address - Zip Code:78605
Practice Address - Country:US
Practice Address - Phone:512-335-9233
Practice Address - Fax:512-355-9230
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00127363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA00127OtherLICENSE
TXR38506Medicare UPIN