Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 40812 | IA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 40812 | IA |
NPI | 1053631317 |
---|---|
Provider Name | Samuel Eliot Stanton |
First Address | Ames, IA 50014-7816 |
Second Address | Ames, IA 50014-7816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2010 |
Last Update Date | 17/09/2021 |