Provider Demographics
NPI:1740241355
Name:STANCIL, JON SCOTT (DPM)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:SCOTT
Last Name:STANCIL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 E FIRE TOWER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4105
Mailing Address - Country:US
Mailing Address - Phone:252-439-1150
Mailing Address - Fax:252-439-1152
Practice Address - Street 1:1432 E FIRE TOWER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4105
Practice Address - Country:US
Practice Address - Phone:252-439-1150
Practice Address - Fax:252-439-1152
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC412213ES0103X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790801AMedicaid
NC0801AOtherBCBS
NC0801AOtherBCBS
NC790801AMedicaid
NC3904030001Medicare NSC