=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285663971
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM STANTON, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 02/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4020 FIFTH AVE SUITE 401
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-713-7900
-----------------------------------------------------
Fax | 619-849-1547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 261532
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92196-1532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-713-7900
-----------------------------------------------------
Fax | 619-849-1547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM STANTON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 619-713-7900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | C34155
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------