Provider Demographics
NPI:1881773828
Name:STANTON, PATRICK KEVIN (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KEVIN
Last Name:STANTON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1600 CENTRAL DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6000
Mailing Address - Country:US
Mailing Address - Phone:817-268-0104
Mailing Address - Fax:817-268-6102
Practice Address - Street 1:1600 CENTRAL DR
Practice Address - Street 2:SUITE 160
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6000
Practice Address - Country:US
Practice Address - Phone:817-268-0104
Practice Address - Fax:817-268-6102
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH0842208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX006895499OtherEEOICP WC
TX10029778OtherAMERIGROUP
TX2038806OtherAETNA HMO
TX528905OtherFIRST HEALTH
TXDOH0842OtherTEXAS WORK COMP
TX050034040OtherRAILROAD MEDICARE
TX116586201Medicaid
TX180403400OtherDEPT OF LABOR KY
TX4389604OtherAETNA PPO
TX86W011OtherBLUE CROSS BLUE SHIELD
TX2038806OtherAETNA HMO
TX180403400OtherDEPT OF LABOR KY