Provider Demographics
NPI:1548262801
Name:STONE, RICHARD L (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:STONE
Suffix:
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 1:1275 N UNIVERSITY AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-7125
Mailing Address - Country:US
Mailing Address - Phone:801-377-4745
Mailing Address - Fax:801-373-5762
Practice Address - Street 1:1275 N UNIVERSITY AVE STE 23
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7125
Practice Address - Country:US
Practice Address - Phone:801-377-4745
Practice Address - Fax:801-373-5762
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT154114-1205207N00000X, 207NS0135X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0300032OtherUHC
07-115-7001OtherMEDICARE RAILROAD
107004856101OtherSELECTHEALTH
QM0000031427OtherALTIUS
0300032OtherUHC
UT000064033Medicare PIN