Provider Demographics
NPI:1609989946
Name:DAVID B STANTON, MD
Entity Type:Organization
Organization Name:DAVID B STANTON, MD
Other - Org Name:GASTRODIAGNOSTICS, A MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-835-3636
Mailing Address - Street 1:1140 W LA VETA AVE
Mailing Address - Street 2:STE 550
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4214
Mailing Address - Country:US
Mailing Address - Phone:714-835-5100
Mailing Address - Fax:714-835-5567
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:STE 550
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4214
Practice Address - Country:US
Practice Address - Phone:714-835-3636
Practice Address - Fax:714-835-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000371261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051272Medicare PIN