Provider Demographics
NPI:1790857241
Name:KANTOR, STANLEY BROOKE (DO)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:BROOKE
Last Name:KANTOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:STANLEY
Other - Middle Name:B
Other - Last Name:KANTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:9208 ROOSEVELT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115
Mailing Address - Country:US
Mailing Address - Phone:206-523-7700
Mailing Address - Fax:206-523-7702
Practice Address - Street 1:9208 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2842
Practice Address - Country:US
Practice Address - Phone:206-523-7700
Practice Address - Fax:206-523-7702
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA252070000OP704207Q00000X
GA16370207Q00000X
MI5101007108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1443407Medicaid
WA14428OtherL I COMP
WA000102624Medicare ID - Type Unspecified
WA1443407Medicaid