Provider Demographics
NPI:1083601801
Name:WU, STANLEY G (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:G
Last Name:WU
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 1:8440 WALNUT HILL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3814
Mailing Address - Country:US
Mailing Address - Phone:214-328-3566
Mailing Address - Fax:214-328-0798
Practice Address - Street 1:8440 WALNUT HILL LN STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3814
Practice Address - Country:US
Practice Address - Phone:214-328-3566
Practice Address - Fax:214-328-0798
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207679603Medicaid
TX207679601Medicaid
TX207679602Medicaid
TX207679606Medicaid
TX207679603Medicaid
TXTXB123264Medicare PIN
TX207679601Medicaid
TX8L21792Medicare PIN
H40071Medicare UPIN
TX8L21803Medicare PIN