Provider Demographics
NPI:1104914050
Name:STONE, BRUCE C (DO)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:C
Last Name:STONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 27TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2056
Mailing Address - Country:US
Mailing Address - Phone:661-631-5686
Mailing Address - Fax:661-631-5683
Practice Address - Street 1:9500 STOCKDALE HWY STE 109
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3621
Practice Address - Country:US
Practice Address - Phone:661-664-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS493208800000X
CA20A5255208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX52550Medicaid
CA00AX52550Medicaid
E32895Medicare UPIN