=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467725473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES L STANTON, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2012
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 B1 WEST ROSEBURG AVENUE
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-491-2500
-----------------------------------------------------
Fax | 209-491-2545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 B1 WEST ROSEBURG AVENUE
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-491-2500
-----------------------------------------------------
Fax | 209-491-2545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. CRIS ROBILLOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-491-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | G30530
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------