Provider Demographics
NPI:1639197247
Name:STONE, MARTIN SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:SPENCER
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 1:10139 NW 31ST ST
Mailing Address - Street 2:SUITE 103
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D55929Medicare UPIN
50976AMedicare ID - Type Unspecified