Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2014014145 | MO |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A158198 | CA |
NPI | 1053654111 |
---|---|
Provider Name | Dr. Jeremy Lee Stanek |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2013 |
Last Update Date | 15/10/2018 |