Provider Demographics
NPI:1659334555
Name:STONER, BRADLEY P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:P
Last Name:STONER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 BROOKINGS DR
Mailing Address - Street 2:BOX 1114
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4862
Mailing Address - Country:US
Mailing Address - Phone:314-935-5673
Mailing Address - Fax:314-935-8535
Practice Address - Street 1:1 BROOKINGS DR
Practice Address - Street 2:BOX 1114
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4862
Practice Address - Country:US
Practice Address - Phone:314-935-5673
Practice Address - Fax:314-935-8535
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-01-05
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Provider Licenses
StateLicense IDTaxonomies
MO107369207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207818709Medicaid
977010183Medicare PIN
440000881Medicare PIN
115011735Medicare PIN
E51674Medicare UPIN