Provider Demographics
NPI:1083858849
Name:STANLEY, JEFFREY PETERSON (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PETERSON
Last Name:STANLEY
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 1:1936 NE 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-5220
Mailing Address - Country:US
Mailing Address - Phone:415-990-4944
Mailing Address - Fax:
Practice Address - Street 1:655 MONTGOMERY ST STE 810
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2677
Practice Address - Country:US
Practice Address - Phone:844-847-8216
Practice Address - Fax:415-520-9150
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD158227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine