Provider Demographics
NPI:1568467603
Name:STONE, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
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 1:801 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-3023
Mailing Address - Country:US
Mailing Address - Phone:479-667-4138
Mailing Address - Fax:479-667-0834
Practice Address - Street 1:801 W RIVER ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-3023
Practice Address - Country:US
Practice Address - Phone:479-667-4138
Practice Address - Fax:479-667-0834
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51260OtherBLUE CROSS OF ARKANSAS
AR51260B477OtherMEDICARE PIN
ARP000173386OtherRAILROAD MEDICARE PIN
AR114722001Medicaid
ARC68116Medicare UPIN
AR51260OtherBLUE CROSS OF ARKANSAS
AR114722001Medicaid