Provider Demographics
NPI:1700811304
Name:JOHN D. STANSELL, M.D., INC
Entity Type:Organization
Organization Name:JOHN D. STANSELL, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:STANSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-778-6769
Mailing Address - Street 1:68135 CONCEPCION RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-3637
Mailing Address - Country:US
Mailing Address - Phone:760-778-6769
Mailing Address - Fax:760-325-4031
Practice Address - Street 1:1751 N SUNRISE WAY
Practice Address - Street 2:SUITE E
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-3408
Practice Address - Country:US
Practice Address - Phone:760-327-2277
Practice Address - Fax:760-325-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2818892261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF7096OtherMEDICARE RAILROAD
DF7096OtherMEDICARE RAILROAD