Healthcare Provider Details

I. General information

NPI: 1225080831
Provider Name (Legal Business Name): JOHN P STAMATO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 W 5TH ST WELCH CANCER CENTER
SHERIDAN WY
82801-2703
US

IV. Provider business mailing address

PO BOX 6607 WYOMING ONCOLOGY
SHERIDAN WY
82801-7101
US

V. Phone/Fax

Practice location:
  • Phone: 307-674-6022
  • Fax: 307-672-9566
Mailing address:
  • Phone: 307-674-1566
  • Fax: 307-674-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberDR.0061192
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5816A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: