Provider Demographics
NPI:1669691838
Name:STONECYPHER, MARK S (MD PHD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:STONECYPHER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:924 BRIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-8543
Mailing Address - Country:US
Mailing Address - Phone:205-515-2971
Mailing Address - Fax:865-380-9191
Practice Address - Street 1:250 E BROADWAY AVE
Practice Address - Street 2:MPLN
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5782
Practice Address - Country:US
Practice Address - Phone:865-380-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT190183207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine