Basic Information
Provider Information | |||||||||
NPI: | 1912967043 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STONE | ||||||||
FirstName: | KENNETH | ||||||||
MiddleName: | ALLEN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | STONE | ||||||||
OtherFirstName: | KEN | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 19845 HAMAL DR | ||||||||
Address2: |   | ||||||||
City: | MONUMENT | ||||||||
State: | CO | ||||||||
PostalCode: | 801329717 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7194819258 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 7500 COCHRANE | ||||||||
Address2: | EVANS ARMY COMMUNITY HOSPITAL BLDG2059 MAGRATH AND YANO | ||||||||
City: | FORT CARSON | ||||||||
State: | CO | ||||||||
PostalCode: | 80913 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7195262939 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/24/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25002 | CO | X |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 2083P0500X | 25002 | CO | X |   | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine |
No ID Information.