Provider Demographics
NPI:1558549709
Name:STANKO, JOHN G (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:STANKO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:702 SW RAMSEY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5859
Mailing Address - Country:US
Mailing Address - Phone:541-472-0603
Mailing Address - Fax:541-472-0609
Practice Address - Street 1:702 SW RAMSEY AVE STE 112
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5859
Practice Address - Country:US
Practice Address - Phone:541-472-0603
Practice Address - Fax:541-472-0609
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500630894Medicaid