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:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37548207Q00000X, 207P00000X
AL30285207P00000X
MN45517207Q00000X
MO2001007179207P00000X
IN01049225A207PE0004X
FLME 97720207Q00000X
TN36565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01049225COtherCONTROLLED SUBST. REGISTR
TN36565OtherLICENSE
FLME 97720OtherFLORIDA MEDICAL LICESNE
MN45517OtherLICENSE
MT10226OtherLICENSE
KY65927196Medicaid
MO2001007179OtherLICENSE
SD4784OtherSD MEDICAL LICENSE
IN01049225AOtherLICENSE
AL30285OtherALABAMA MEDICAL LICENSE
KY37548OtherLICENSE
UT4776372-1205OtherLICENSE
UT4776372-8905OtherCONTROLLED SUBST REGISTR.
ND8509OtherLICENSE
KYG94703Medicare UPIN