Healthcare Provider Details

I. General information

NPI: 1831710631
Provider Name (Legal Business Name): ROSS C STANTON MD, JD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SAINT ELIZABETH BLVD STE 4000
O FALLON IL
62269-1284
US

IV. Provider business mailing address

3 SAINT ELIZABETH BLVD STE 4000
O FALLON IL
62269-1284
US

V. Phone/Fax

Practice location:
  • Phone: 618-222-4600
  • Fax: 618-222-4792
Mailing address:
  • Phone: 618-222-4600
  • Fax: 618-256-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.175690
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35977
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: