Provider Demographics
NPI:1942665989
Name:STANTON, MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:
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 1:1160 TONKAWA RD
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:MN
Mailing Address - Zip Code:55356-9240
Mailing Address - Country:US
Mailing Address - Phone:612-723-7276
Mailing Address - Fax:
Practice Address - Street 1:1160 TONKAWA RD
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:MN
Practice Address - Zip Code:55356-9240
Practice Address - Country:US
Practice Address - Phone:612-723-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27995174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27995OtherMEDICAL LICENSE