Provider Demographics
NPI:1417392812
Name:ELSEROAD, STANTON (MD)
Entity Type:Individual
Prefix:
First Name:STANTON
Middle Name:
Last Name:ELSEROAD
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 1:1900 N WINSTON RD
Mailing Address - Street 2:300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3606
Mailing Address - Country:US
Mailing Address - Phone:865-539-8000
Mailing Address - Fax:
Practice Address - Street 1:1900 N WINSTON RD
Practice Address - Street 2:300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3606
Practice Address - Country:US
Practice Address - Phone:865-539-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53053207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program