Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | F7930 | TX |
NPI | 1023088986 |
---|---|
Provider Name | Michael D Stanley |
First Address | Fort Worth, TX 76109-2409 |
Second Address | Richardson, TX 75082-3542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P085455F8 | (05) | TX |