Provider Demographics
NPI:1205884012
Name:STONE, ERICK DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:DOUGLAS
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 1:401 E LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2127
Mailing Address - Country:US
Mailing Address - Phone:626-963-4243
Mailing Address - Fax:626-963-0051
Practice Address - Street 1:401 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2127
Practice Address - Country:US
Practice Address - Phone:626-963-4243
Practice Address - Fax:626-963-0051
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48398207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G483980Medicaid