Provider Demographics
NPI:1942433537
Name:STONE, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:STONE
Suffix:
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 1:1965 W FAIRY CHASM RD
Mailing Address - Street 2:
Mailing Address - City:RIVER HILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1532
Mailing Address - Country:US
Mailing Address - Phone:414-351-4395
Mailing Address - Fax:
Practice Address - Street 1:1965 W FAIRY CHASM RD
Practice Address - Street 2:
Practice Address - City:RIVER HILLS
Practice Address - State:WI
Practice Address - Zip Code:53217-1532
Practice Address - Country:US
Practice Address - Phone:414-351-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19728208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice