Provider Demographics
NPI:1750335055
Name:BONE, WILLIAM MASON (MD, PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MASON
Last Name:BONE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-5577
Mailing Address - Country:US
Mailing Address - Phone:660-826-8833
Mailing Address - Fax:660-829-6611
Practice Address - Street 1:2846 WALLACE LAKE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571
Practice Address - Country:US
Practice Address - Phone:850-995-7273
Practice Address - Fax:347-214-8207
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37548207P00000X, 207Q00000X
AL30285207P00000X
IN01049225A207PE0004X
FLME 97720207Q00000X
MN45517207Q00000X
TN36565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4776372-8905OtherCONTROLLED SUBST REGISTR.
FLME 97720OtherFLORIDA MEDICAL LICESNE
IN01049225AOtherLICENSE
IN01049225COtherCONTROLLED SUBST. REGISTR
SD4784OtherSD MEDICAL LICENSE
AL30285OtherALABAMA MEDICAL LICENSE
MN45517OtherLICENSE
MT10226OtherLICENSE
KY65927196Medicaid
MO2001007179OtherLICENSE
UT4776372-1205OtherLICENSE
ND8509OtherLICENSE
TN36565OtherLICENSE
KY37548OtherLICENSE
KYG94703Medicare UPIN