Provider Demographics
NPI:1548202799
Name:STONE, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
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 1:718 CREEK HILL WAY
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-4278
Mailing Address - Country:US
Mailing Address - Phone:940-255-8060
Mailing Address - Fax:
Practice Address - Street 1:718 CREEK HILL WAY
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-4278
Practice Address - Country:US
Practice Address - Phone:940-255-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20371202K00000X, 207P00000X, 207Q00000X
FLME93787207R00000X
CA139302207R00000X
TXN1163207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4624Medicaid
TX202266704Medicaid
TX292521Medicare PIN
SCG80894Medicare UPIN
SC8583Medicare PIN
TX298932YLLYMedicare PIN
TX202266704Medicaid
TXTXB155426Medicare PIN
TX298932YUAVMedicare PIN
TX298932YSWXMedicare UPIN
SCG808948583Medicare PIN