Provider Demographics
NPI:1467725473
Name:JAMES L STANTON, MD INC
Entity Type:Organization
Organization Name:JAMES L STANTON, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBILLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-491-2500
Mailing Address - Street 1:200 B1 WEST ROSEBURG AVENUE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-491-2500
Mailing Address - Fax:209-491-2545
Practice Address - Street 1:200 B1 WEST ROSEBURG AVENUE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-491-2500
Practice Address - Fax:209-491-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS6776249OtherDEA