Provider Demographics
NPI:1083642284
Name:STANEC, JOHN MARKWITH (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARKWITH
Last Name:STANEC
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 1:425 37TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2812
Mailing Address - Country:US
Mailing Address - Phone:650-224-8804
Mailing Address - Fax:
Practice Address - Street 1:3875 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2428
Practice Address - Country:US
Practice Address - Phone:510-547-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73640207L00000X
IA37264207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A736400Medicaid
CA00A736400Medicaid
IAP00763349Medicare PIN
H82912Medicare UPIN
00A736400Medicare ID - Type Unspecified