Individual
DR. JERRY MICHAEL STANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1600 CENTRAL DR, SUITE 160, BEDFORD, TX 76022-6000
(817) 268-0104
(817) 268-6102
Mailing address
1600 CENTRAL DR, SUITE 160, BEDFORD, TX 76022-6000
(817) 268-0104
(817) 268-6102
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
G1555
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006895499
EEOICP
MD
01
—
050033686
RAILROAD MEDICARE
GA
01
—
10028066
AMERIGROUP
TX
05
—
116585401
—
TX
01
—
180403400
DEPT OF LABOR LONDON KY
TX
01
—
2028260
AETNA HMO
TX
01
—
4389652
AETNA PPO
TX
01
—
528901
FIRST HEALTH
TX
01
—
86W010
BLUE CROSS BLUE SHIELD TX
TX
01
—
DOG1555
TEXAS WORK COMP
TX
Enumeration date
07/20/2006
Last updated
03/07/2013
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