Provider Demographics
NPI:1629182647
Name:STONE, JEFFREY ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:STONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 COIT ROAD
Mailing Address - Street 2:SUITE 220, PMB 197
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5847
Mailing Address - Country:US
Mailing Address - Phone:214-265-9408
Mailing Address - Fax:
Practice Address - Street 1:5605 N. MACARTHUR BLVD.
Practice Address - Street 2:SUITE 400
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2617
Practice Address - Country:US
Practice Address - Phone:214-265-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1404208D00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123265705Medicaid
TX123265705Medicaid
85190JMedicare ID - Type Unspecified