Provider Demographics
NPI:1588721278
Name:STANTON, BOB L (DPM)
Entity type:Individual
Prefix:DR
First Name:BOB
Middle Name:L
Last Name:STANTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 NASSAU ST
Mailing Address - Street 2:STE 101
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4137
Mailing Address - Country:US
Mailing Address - Phone:425-339-8888
Mailing Address - Fax:425-258-6933
Practice Address - Street 1:3131 NASSAU ST
Practice Address - Street 2:STE 101
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4137
Practice Address - Country:US
Practice Address - Phone:425-339-8888
Practice Address - Fax:425-258-6933
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000357213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000105151Medicare PIN
WA4711020001Medicare NSC
T01844Medicare UPIN