Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301096614 | MI |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 9374 | ND |
NPI | 1003838665 |
---|---|
Provider Name | Jeffrey John Stanley |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 06/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12388 | (05) | ND |
702616100 | (05) | MN |
G99880 | (02) | |
G99880 | (02) | MI |