Individual
THADDEUS MICHAEL STANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
525 WESTERN AVE, SUITE 203, CONWAY, AR 72034-4967
(501) 327-4828
(501) 327-6899
Mailing address
525 WESTERN AVE, SUITE 203, CONWAY, AR 72034-4967
(501) 327-4828
(501) 327-6899
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
C6890
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02009881
MEDICARE RAILROAD
AR
05
—
111393001
—
AR
01
—
15289000000
QUALCHOICE
AR
01
—
4339027
AETNA
AR
Enumeration date
08/10/2005
Last updated
11/18/2009
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