Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | G1205 | TX |
NPI | 1447224357 |
---|---|
Provider Name | Dr. Earl Austin Stanley JR. |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 30/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136235210 | (05) | TX |
C22173 | (02) |