Provider Demographics
NPI:1043247703
Name:CORLEY, STANLEY D (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:D
Last Name:CORLEY
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 1:5201 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2004
Mailing Address - Country:US
Mailing Address - Phone:405-486-0826
Mailing Address - Fax:405-749-9566
Practice Address - Street 1:5201 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142
Practice Address - Country:US
Practice Address - Phone:405-755-4050
Practice Address - Fax:405-749-9566
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100750AMedicaid
OK15340OtherOBNDD
OK080156330OtherRAILROAD
OK12345OtherLICENSE
D34543Medicare UPIN
OK080156330OtherRAILROAD