Provider Demographics
NPI:1679592398
Name:STONE, JEFFERY DAVIS (MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:DAVIS
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5295 PRESERVE PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-987-4444
Mailing Address - Fax:205-987-4451
Practice Address - Street 1:5295 PRESERVE PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-987-4444
Practice Address - Fax:205-987-4451
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911015Medicaid
AL51510248OtherBLUE CROSS OF ALABAMA
AL51510249OtherBLUE CROSS OF ALABAMA
AL009996780Medicaid
AL009911015Medicaid