Provider Demographics
NPI:1487616538
Name:STATON, DAVID STANLEY (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:STANLEY
Last Name:STATON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:S
Other - Last Name:STATON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:124 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-9718
Mailing Address - Country:US
Mailing Address - Phone:318-746-3837
Mailing Address - Fax:318-841-4796
Practice Address - Street 1:OVERTON BROOKS VAMC
Practice Address - Street 2:510 EAST STONER AVE
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:318-841-4796
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical