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General NPI Number Information
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NPI Number | 1184894875
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Entity Type | Organization
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Legal Business Name | JON S STANCIL
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 1432 E FIRE TOWER RD
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City | GREENVILLE
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State | NC
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Zip | 27858-4105
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Country | US
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Telephone | 252-439-1150
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Fax | 252-439-1152
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Provider Business Mailing Address
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Address Line | 1432 E FIRE TOWER RD
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City | GREENVILLE
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State | NC
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Zip | 27858-4105
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Country | US
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Telephone | 252-439-1150
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Fax | 252-439-1152
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Authorized Official
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Title or Position | OWNER
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Name | DR. JON SCOTT STANCIL
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Credential | DPM
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Telephone | 252-439-1150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 412
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License Number State | NC
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