Provider Demographics
NPI:1104054295
Name:STONE, SHANE F (MD)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:F
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 1:2509 SCRIPTURE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2337
Mailing Address - Country:US
Mailing Address - Phone:940-898-7400
Mailing Address - Fax:940-387-7327
Practice Address - Street 1:2509 SCRIPTURE ST STE 200
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2337
Practice Address - Country:US
Practice Address - Phone:940-898-7400
Practice Address - Fax:940-387-7327
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL31985207Q00000X
390200000X
NC2013-01885207Q00000X
TXQ4851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2247Medicaid
NC1104054295Medicaid
NCNCE531BMedicare PIN
NCNCE531DMedicare PIN
NCNCE531AMedicare PIN
NC1104054295Medicaid
NCNCE531CMedicare PIN