Healthcare Provider Details

I. General information

NPI: 1063671147
Provider Name (Legal Business Name): KRISTOPHER T. STANTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 5TH AVE SUITE 200W
SPOKANE WA
99204-4880
US

IV. Provider business mailing address

12606 E MISSION AVE
SPOKANE VALLEY WA
99216-3421
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-2313
  • Fax: 509-459-0686
Mailing address:
  • Phone: 509-473-5885
  • Fax: 509-459-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberML20008800
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60058256
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60058256
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: