Provider Demographics
NPI:1346316437
Name:STANTON, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
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 1:2402 FRIST BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4838
Mailing Address - Country:US
Mailing Address - Phone:772-465-4651
Mailing Address - Fax:772-465-4606
Practice Address - Street 1:2402 FRIST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4838
Practice Address - Country:US
Practice Address - Phone:772-465-4651
Practice Address - Fax:772-465-4606
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 63808207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277449600Medicaid
FLP00415007OtherMEDICARE RAIL ROAD
FL277449600Medicaid
FLP0041515007Medicare PIN
FLP00415007OtherMEDICARE RAIL ROAD
FL81578YMedicare PIN