Provider Demographics
NPI:1629384920
Name:MARTIN SPENCER STONE MD PA
Entity Type:Organization
Organization Name:MARTIN SPENCER STONE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-755-0350
Mailing Address - Street 1:10139 NW 31ST ST
Mailing Address - Street 2:SUITE103
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3908
Mailing Address - Country:US
Mailing Address - Phone:954-755-0350
Mailing Address - Fax:866-480-1605
Practice Address - Street 1:10139 NW 31ST ST
Practice Address - Street 2:SUITE103
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3908
Practice Address - Country:US
Practice Address - Phone:954-755-0350
Practice Address - Fax:866-480-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50976AMedicare PIN