Provider Demographics
NPI:1003017427
Name:LUE, STANLEY GARKEN (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:GARKEN
Last Name:LUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 METRO PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1206
Mailing Address - Country:US
Mailing Address - Phone:239-208-2212
Mailing Address - Fax:239-208-3994
Practice Address - Street 1:11215 METRO PKWY STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1206
Practice Address - Country:US
Practice Address - Phone:239-208-2212
Practice Address - Fax:239-208-3994
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4661892084N0400X
WAMD603659892084N0400X
MI43011144452084N0400X
NC2016-006702084N0400X
NE291932084N0400X
NY2927092084N0400X
TXN21782084N0400X
NH178362084N0400X
MO20200039292084N0400X
FLTRN8973390200000X
FLMD1273982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01029758OtherRAILROAD
TX284386401Medicaid
TX284386402Medicaid
NH3115768Medicaid
TXTXB130901Medicare PIN