Provider Demographics
NPI:1023322039
Name:STONE, WILLIAM TYLER (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TYLER
Last Name:STONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 PEACEFUL PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-3357
Mailing Address - Country:US
Mailing Address - Phone:719-439-3461
Mailing Address - Fax:719-358-9860
Practice Address - Street 1:1715 N WEBER ST
Practice Address - Street 2:SUITE 120
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7532
Practice Address - Country:US
Practice Address - Phone:719-722-4929
Practice Address - Fax:719-358-9860
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010172992084N0400X
CO492152084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72728850Medicaid
CO307478YUAYMedicare PIN