MEDICARE: STANTON H. JOE, M.D., A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center	G22870	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417039942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANTON H. JOE, M.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1809 VERDUGO BLVD
Second Line	:	SUITE 100
City	:	GLENDALE
State	:	CA
Zip	:	91208-1402
Country	:	US
Telephone Number	:	818-790-9300
Fax Number	:	818-790-4564

Provider Business Practice Location Address
First Line	:	1300 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2506
Country	:	US
Telephone Number	:	818-790-9300
Fax Number	:	818-790-9300

Authorized Official
Title or Position	:	RADIOLOGIST
Name	:	DR. STANTON HENRY JOE
Credential	:	M.D.
Telephone Number	:	818-790-9300

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	02/02/2018

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