Provider Demographics
NPI:1053373233
Name:TONI C STOCKTON MD PLLC
Entity type:Organization
Organization Name:TONI C STOCKTON MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TONI
Authorized Official - Middle Name:CYD
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-610-6366
Mailing Address - Street 1:16611 S. 40 STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048
Mailing Address - Country:US
Mailing Address - Phone:480-610-6366
Mailing Address - Fax:480-833-1653
Practice Address - Street 1:16611 S. 40 STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048
Practice Address - Country:US
Practice Address - Phone:480-610-6366
Practice Address - Fax:480-833-1653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22013207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070015724OtherMEDICARE RAILROAD
AZ1Z6275OtherHEALTHNET HEALTHCARE
AZAZ0875010OtherBLUE CROSS BLUE SHIELD
A93288Medicare UPIN
AZAZ0875010OtherBLUE CROSS BLUE SHIELD