Provider Demographics
NPI:1538340823
Name:STONER, JOSHUA DALE (PA-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DALE
Last Name:STONER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 TILDEN
Mailing Address - Street 2:
Mailing Address - City:COTULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78014-2161
Mailing Address - Country:US
Mailing Address - Phone:830-879-2358
Mailing Address - Fax:830-879-3107
Practice Address - Street 1:207 TILDEN
Practice Address - Street 2:
Practice Address - City:COTULLA
Practice Address - State:TX
Practice Address - Zip Code:78014-2161
Practice Address - Country:US
Practice Address - Phone:830-879-2358
Practice Address - Fax:830-879-3107
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05353OtherPA LICENSE