Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 036-100572 | IL |
Y | 2081P2900X | Pain Medicine | 036-100572 | IL |
NPI | 1053329615 |
---|---|
Provider Name | Steven Stanos JR. |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98104-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 19/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036100572 | (05) | IL |
250014002 | RAILROAD MEDICARE (01) | IL |
250014003 | RAILROAD MEDICARE (01) | IL |
H09928 | (02) |