MEDICARE: STANTON C. PACKARD M.D.

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	207Q00000X	Family Medicine Physician	J6641	TX
2	207P00000X	Emergency Medicine Physician	J6641	TX

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

General Provider Information

NPI Number	:	1902902257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANTON C. PACKARD M.D.

Provider Business Mailing Address
First Line	:	4002 BURKE RD
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-3451
Country	:	US
Telephone Number	:	281-606-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 BURKE RD
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-3451
Country	:	US
Telephone Number	:	281-606-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	08/01/2013

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Directions to “ STANTON C. PACKARD M.D.” Practice Location

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