Provider Demographics
NPI:1346249596
Name:STANLEY, GARY E (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:E
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:PO BOX 2927
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71207-2927
Mailing Address - Country:US
Mailing Address - Phone:318-323-8824
Mailing Address - Fax:318-323-8823
Practice Address - Street 1:920 OLIVER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5702
Practice Address - Country:US
Practice Address - Phone:318-323-8824
Practice Address - Fax:318-323-8823
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022011208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG33937Medicare UPIN