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General NPI Number Information
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NPI Number | 1790857241
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Entity Type | Individual
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Provider Name | STANLEY BROOKE KANTOR DO
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 9208 ROOSEVELT WAY NE
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City | SEATTLE
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State | WA
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Zip | 98115-2842
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Country | US
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Telephone | 206-523-7700
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Fax | 206-523-7702
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Provider Business Mailing Address
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Address Line | 9208 ROOSEVELT WAY NE
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City | SEATTLE
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State | WA
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Zip | 98115
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Country | US
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Telephone | 206-523-7700
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Fax | 206-523-7702
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 252070000OP704
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16370
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101007108
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License Number State | MI
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