Provider Demographics
NPI:1780644138
Name:STONE, KIMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:STONE
Suffix:
Gender:F
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:PO BOX 746093
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6093
Mailing Address - Country:US
Mailing Address - Phone:773-352-1517
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:10705 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-4061
Practice Address - Country:US
Practice Address - Phone:623-259-6749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0716570OtherBCBS
AZ102113OtherMEDICARE-TYPE UNSPECIFIED
AZ110238540OtherRR MEDICARE
AZ102147OtherMEDICARE-TYPE UNSPECIFIED
AZZ70496Medicare ID - Type Unspecified
AZ102147OtherMEDICARE-TYPE UNSPECIFIED