Provider Demographics
NPI:1114111580
Name:STANLY T SELBY, M.D.
Entity Type:Organization
Organization Name:STANLY T SELBY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-695-4030
Mailing Address - Street 1:1115 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-7929
Mailing Address - Country:US
Mailing Address - Phone:325-695-4030
Mailing Address - Fax:325-695-4032
Practice Address - Street 1:1115 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7929
Practice Address - Country:US
Practice Address - Phone:325-695-4030
Practice Address - Fax:325-695-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DR62OtherBCBS
TX00DR62OtherBCBS
TX00847TMedicare PIN