Provider Demographics
NPI:1851339121
Name:STONER-BRYAN, DEBORAH DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:DIANE
Last Name:STONER-BRYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:DIANE
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:503 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2221
Mailing Address - Country:US
Mailing Address - Phone:785-742-4100
Mailing Address - Fax:785-742-4101
Practice Address - Street 1:503 OREGON ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2221
Practice Address - Country:US
Practice Address - Phone:785-742-4100
Practice Address - Fax:785-742-4101
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00126676OtherRAILROAD MEDICARE
MO208535849Medicaid
MO26204048OtherBLUE CROSS OF KANSAS CITY
H98A154Medicare ID - Type Unspecified
MO26204048OtherBLUE CROSS OF KANSAS CITY