Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | Q0572 | TX |
NPI | 1023363249 |
---|---|
Provider Name | Dr. Douglas James Stanley |
First Address | Fredericksburg, TX 78624-4479 |
Second Address | Boerne, TX 78006-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2012 |
Last Update Date | 27/09/2016 |