Provider Demographics
NPI:1942200811
Name:STANTON, JAMES LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEWIS
Last Name:STANTON
Suffix:
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 1:200 B1 WEST ROSEBURG AVENUE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-491-2500
Mailing Address - Fax:209-491-2545
Practice Address - Street 1:200 B1 WEST ROSEBURG
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-491-2500
Practice Address - Fax:209-491-2545
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44452Medicare UPIN