Provider Demographics
NPI:1306948062
Name:STONE, JANINE ANN (MD)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:ANN
Last Name:STONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:ANN
Other - Last Name:KLOBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-955-6500
Mailing Address - Fax:208-955-6503
Practice Address - Street 1:7350 W VICTORY RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-4237
Practice Address - Country:US
Practice Address - Phone:208-809-2888
Practice Address - Fax:208-809-2889
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26329207Q00000X
IDM-10355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200296730Medicaid
G74213Medicare UPIN
090540MMedicare ID - Type Unspecified