Provider Demographics
NPI:1649255324
Name:STONE, MARSHALL M (MD,)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:M
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 1:1002 S OLD DIXIE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7202
Mailing Address - Country:US
Mailing Address - Phone:561-852-0038
Mailing Address - Fax:561-852-2261
Practice Address - Street 1:1002 S OLD DIXIE HWY STE 101
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7202
Practice Address - Country:US
Practice Address - Phone:561-852-0038
Practice Address - Fax:561-852-2261
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME580112086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063855200Medicaid
FL257033500Medicaid
FLAS1942487OtherDEA NUMBER
FL063855200Medicaid