Provider Demographics
NPI:1285735969
Name:DETURE STONE ASSOCIATES, PA
Entity type:Organization
Organization Name:DETURE STONE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-303-2860
Mailing Address - Street 1:2501 N ORANGE AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-303-2860
Mailing Address - Fax:407-303-2862
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-303-2860
Practice Address - Fax:407-303-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259664400Medicaid
FL259664400Medicaid