Provider Demographics
NPI:1699855445
Name:STANTON, THOMAS SPENCER II (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SPENCER
Last Name:STANTON
Suffix:II
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 1:110 LYNCH CREEK WAY STE A
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2337
Mailing Address - Country:US
Mailing Address - Phone:707-763-0600
Mailing Address - Fax:707-765-1757
Practice Address - Street 1:110 LYNCH CREEK WAY STE A
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2337
Practice Address - Country:US
Practice Address - Phone:707-763-0600
Practice Address - Fax:707-765-1757
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63014207RH0000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G630140Medicaid
E84239Medicare UPIN
CA00G630140Medicaid