Provider Demographics
NPI:1346355872
Name:DAY, STANLEY TYLER (M D)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:TYLER
Last Name:DAY
Suffix:
Gender:M
Credentials:M D
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 179
Mailing Address - Street 2:
Mailing Address - City:NIMITZ
Mailing Address - State:WV
Mailing Address - Zip Code:25978-0179
Mailing Address - Country:US
Mailing Address - Phone:304-466-2501
Mailing Address - Fax:304-466-2513
Practice Address - Street 1:197 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2540
Practice Address - Country:US
Practice Address - Phone:304-466-2501
Practice Address - Fax:304-466-2513
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0056758000Medicaid
WV0034320000Medicaid
WVA72244Medicare UPIN
WV51-3843Medicare ID - Type UnspecifiedRHC MEDICARE
WV9308851Medicare ID - Type UnspecifiedPALMETTO GBA MEDICARE
WV020005026Medicare ID - Type UnspecifiedPALMETTO GBA RR MEDICARE