Provider Demographics
NPI:1962575183
Name:SCHILLER, STANTON ROSS (MD)
Entity type:Individual
Prefix:
First Name:STANTON
Middle Name:ROSS
Last Name:SCHILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHIPPENHAM LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-6801
Mailing Address - Country:US
Mailing Address - Phone:636-394-7900
Mailing Address - Fax:636-394-7900
Practice Address - Street 1:100 MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367
Practice Address - Country:US
Practice Address - Phone:636-625-5200
Practice Address - Fax:636-625-5376
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6509207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR6509OtherSTATE LICENSE
D15151Medicare UPIN