Provider Demographics
NPI:1871550111
Name:STANLEY, BETTYE DELOIS (DO)
Entity type:Individual
Prefix:
First Name:BETTYE
Middle Name:DELOIS
Last Name:STANLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 ROLLING HILLS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5011
Mailing Address - Country:US
Mailing Address - Phone:804-249-8302
Mailing Address - Fax:804-249-8321
Practice Address - Street 1:1601 ROLLING HILLS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5011
Practice Address - Country:US
Practice Address - Phone:804-249-8302
Practice Address - Fax:804-249-8321
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050193207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE25572Medicare UPIN