Provider Demographics
NPI:1538229711
Name:STONER, CHARLES HERSHEL JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:HERSHEL
Last Name:STONER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17841 PIERRE PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:402-991-7000
Mailing Address - Fax:402-991-7999
Practice Address - Street 1:17841 PIERRE PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:402-991-7000
Practice Address - Fax:402-991-7999
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10231OtherMIDLANDS CHOICE
NE10024979400Medicaid
03896OtherBCBS
NE10024979400Medicaid
10231OtherMIDLANDS CHOICE