Provider Demographics
NPI:1053631317
Name:STANTON, SAMUEL ELIOT (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ELIOT
Last Name:STANTON
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 1:925 GASKILL DR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-7816
Mailing Address - Country:US
Mailing Address - Phone:515-231-7309
Mailing Address - Fax:888-806-4041
Practice Address - Street 1:925 GASKILL DR
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7816
Practice Address - Country:US
Practice Address - Phone:515-231-7309
Practice Address - Fax:888-806-4041
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40812207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine