Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 00006413 | AL |
NPI | 1083612899 |
---|---|
Provider Name | John Everett Stone JR. |
First Address | Mobile, AL 36607-2301 |
Second Address | Mobile, AL 36607-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
510-51949 | BLUE CROSS/BLUE SHIELD (01) | AL |
C76401 | (02) |