Provider Demographics
NPI:1881622736
Name:STONE, IRA MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:MICHAEL
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6170 A1A SOUTH
Mailing Address - Street 2:UNIT 221
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080
Mailing Address - Country:US
Mailing Address - Phone:904-471-2716
Mailing Address - Fax:352-873-9615
Practice Address - Street 1:6170 A1A SOUTH
Practice Address - Street 2:UNIT 221
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080
Practice Address - Country:US
Practice Address - Phone:904-471-2716
Practice Address - Fax:352-873-9615
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-11-30
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Provider Licenses
StateLicense IDTaxonomies
FLME30440207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D54780Medicare UPIN
FL42121XMedicare Oscar/Certification
FL42121XMedicare PIN