Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G88917 | CA |
NPI | 1013907286 |
---|---|
Provider Name | Brian Douglass Stone |
First Address | Charlotte, NC 28260-3725 |
Second Address | San Diego, CA 92108-1633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 19/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CB223486 | MEDICARE PTAN (01) | CA |
CB223775 | MEDICARE PTAN (01) | CA |