Provider Demographics
NPI:1598047292
Name:STANTON, ROBERT BRIAN (NBC-HIS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRIAN
Last Name:STANTON
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 PENNINGER DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2700
Mailing Address - Country:US
Mailing Address - Phone:208-371-1805
Mailing Address - Fax:
Practice Address - Street 1:1801 PENNINGER DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2700
Practice Address - Country:US
Practice Address - Phone:208-371-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA239237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist