Provider Demographics
NPI:1174589030
Name:STONE, VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YOSHIHIDE
Other - Middle Name:
Other - Last Name:ISHII
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1602 GOVERNORS DR
Mailing Address - Street 2:APT 2624
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-9442
Mailing Address - Country:US
Mailing Address - Phone:215-805-6629
Mailing Address - Fax:
Practice Address - Street 1:1602 GOVERNORS DR
Practice Address - Street 2:APT 2624
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9442
Practice Address - Country:US
Practice Address - Phone:215-805-6629
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239092171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101239092OtherSTATE MEDICAL LINCENSE