Provider Demographics
NPI:1871589085
Name:STANLEY, DOUGLAS S (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7780 N FRESNO ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2413
Mailing Address - Country:US
Mailing Address - Phone:559-447-9027
Mailing Address - Fax:559-447-1675
Practice Address - Street 1:7780 N FRESNO ST
Practice Address - Street 2:STE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2413
Practice Address - Country:US
Practice Address - Phone:559-447-9027
Practice Address - Fax:559-447-1675
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2008-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA71417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H61963Medicare UPIN