Healthcare Provider Details

I. General information

NPI: 1811940224
Provider Name (Legal Business Name): MARCUS DUANE STANBRO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR STE B260
GREENVILLE SC
29615-6328
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-2852
  • Fax: 864-454-2899
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number662
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: