Provider Demographics
NPI:1760669766
Name:RICHARD L STONE MD PC
Entity Type:Organization
Organization Name:RICHARD L STONE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-377-4745
Mailing Address - Street 1:1275 N UNIVERSITY AVE
Mailing Address - Street 2:23
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2654
Mailing Address - Country:US
Mailing Address - Phone:801-377-4745
Mailing Address - Fax:801-373-5762
Practice Address - Street 1:1275 N UNIVERSITY AVE
Practice Address - Street 2:23
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2654
Practice Address - Country:US
Practice Address - Phone:801-377-4745
Practice Address - Fax:801-373-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT154114-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD20144Medicare UPIN
UT000000489Medicare PIN