Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | C7540 | AR |
N | 207QA0505X | Family Doctor - Adult Medicine | C7540 | AR |
N | 207QG0300X | Family Doctor - Geriatric Medicine | C7540 | AR |
Y | 207R00000X | Internist | C7540 | AR |
Y | 111NI0900X | Internist | C7540 | AR |
N | 207RG0300X | Geriatric Medicine | C7540 | AR |
N | 207RN0300X | Nephrologist | C7540 | AR |
NPI | 1114903879 |
---|---|
Provider Name | Dr. Robert Lawrence Stanley |
First Address | Little Rock, AR 72211-4393 |
Second Address | North Little Rock, AR 72117-2949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 20/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110190364 | RR MCARE PROVIDER NUMBER (01) | AR |
11243000000 | QUALCHOICE PROVIDER NUMBE (01) | AR |
121551001 | (05) | AR |
420280 | UNITED HEALTHCARE NUMBER (01) | AR |
5487062 | AETNA PROVIDER NUMBER (01) | AR |
F27711 | (02) | AR |