Provider Demographics
NPI:1770598757
Name:STONE, LASZLO S (MD)
Entity type:Individual
Prefix:DR
First Name:LASZLO
Middle Name:S
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LASZLO
Other - Middle Name:
Other - Last Name:SZTONAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12620 BEACH BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7130
Mailing Address - Country:US
Mailing Address - Phone:904-645-0777
Mailing Address - Fax:904-645-3483
Practice Address - Street 1:12620 BEACH BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7130
Practice Address - Country:US
Practice Address - Phone:904-645-0777
Practice Address - Fax:904-645-3483
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 100423208D00000X
CAA95192208D00000X
WAMD00044413208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
8856100Medicare PIN
I 41753Medicare UPIN
8856100Medicare PIN
8856100Medicare PIN