Provider Demographics
NPI:1457524548
Name:STANTON, KEVAN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVAN
Middle Name:CHRISTOPHER
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 1:1128 NE 2ND ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6230
Mailing Address - Country:US
Mailing Address - Phone:203-507-0159
Mailing Address - Fax:
Practice Address - Street 1:1128 NE 2ND ST STE 103
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6230
Practice Address - Country:US
Practice Address - Phone:203-507-0159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD162067207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500661662Medicaid