Provider Demographics
NPI:1497801179
Name:STANLEY, CHRISTOPHER D (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 N HARRISON AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2376
Mailing Address - Country:US
Mailing Address - Phone:605-945-1371
Mailing Address - Fax:605-945-3237
Practice Address - Street 1:800 E DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3313
Practice Address - Country:US
Practice Address - Phone:605-224-3199
Practice Address - Fax:605-945-3237
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD75552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00741143OtherRAILROAD MEDICARE
SDS103404Medicare PIN