Individual
ANDREW STANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11782 SW BARNES RD, PORTLAND, OR 97225-5914
(503) 214-5200
Mailing address
3890 SW 94TH AVE, PORTLAND, OR 97225-2507
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA190662
OR
363AS0400X
Surgical Physician Assistant
Primary
PA190662
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500754932
—
OR
01
—
PA190662
PA LICENSE
OR
Enumeration date
10/10/2018
Last updated
05/23/2022
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