Provider Demographics
NPI:1194017996
Name:STANTON, JARED A (DPM)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:A
Last Name:STANTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 MERCY WAY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-556-2278
Mailing Address - Fax:417-556-2277
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:SUITE 420
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-556-2278
Practice Address - Fax:417-556-2277
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901002415213ES0103X
MO2016021074213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery