Provider Demographics
NPI:1497756407
Name:GATELY, STANLEY E (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:E
Last Name:GATELY
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 1351
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-1351
Mailing Address - Country:US
Mailing Address - Phone:800-235-1415
Mailing Address - Fax:
Practice Address - Street 1:1808 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2724
Practice Address - Country:US
Practice Address - Phone:479-968-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6606207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113710001Medicaid
AR51200OtherBLUE CROSS BLUE SHIELD AR
050032849OtherRR MEDICAR GROUP CC5970
AR770078101OtherAR BREASTCARE
AR770078101OtherAR BREASTCARE
AR512007607Medicare PIN