Provider Demographics
NPI:1225037302
Name:STANLEY, RONALD J (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
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 1:169 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5069
Mailing Address - Country:US
Mailing Address - Phone:828-264-4553
Mailing Address - Fax:828-262-3649
Practice Address - Street 1:169 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5069
Practice Address - Country:US
Practice Address - Phone:828-264-4553
Practice Address - Fax:828-262-3649
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18060207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8979292Medicaid
210652Medicare ID - Type Unspecified
D33180Medicare UPIN