Provider Demographics
NPI:1093987414
Name:CATHEY, STANLEY RAY (PA)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:RAY
Last Name:CATHEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:CATHEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:8719 MORENO CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1843
Mailing Address - Country:US
Mailing Address - Phone:209-269-0120
Mailing Address - Fax:209-476-1962
Practice Address - Street 1:8719 MORENO CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1843
Practice Address - Country:US
Practice Address - Phone:209-269-0120
Practice Address - Fax:209-476-1962
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11382363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical