Provider Demographics
NPI:1982698544
Name:STONE, ELIZABETH JEAN (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:STONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 NW CULPEPPER TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3121
Mailing Address - Country:US
Mailing Address - Phone:503-243-2177
Mailing Address - Fax:503-241-2434
Practice Address - Street 1:646 NW CULPEPPER TER
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3121
Practice Address - Country:US
Practice Address - Phone:503-243-2177
Practice Address - Fax:503-241-2434
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8334208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240007086OtherMC RR
OR180547Medicaid
OR0006252000OtherREGUCE BLUE CROSS
116988Medicare PIN
OR0006252000OtherREGUCE BLUE CROSS
OR116988Medicare ID - Type Unspecified