Provider Demographics
NPI:1770689267
Name:STONE, VAN D III (MD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:D
Last Name:STONE
Suffix:III
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 1:1573 MEDICAL PARK CIR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6580
Mailing Address - Country:US
Mailing Address - Phone:662-844-9885
Mailing Address - Fax:662-842-1350
Practice Address - Street 1:1573 MEDICAL PARK CIR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6580
Practice Address - Country:US
Practice Address - Phone:662-844-9885
Practice Address - Fax:662-842-1350
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10444208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00111924Medicaid