Provider Demographics
NPI:1548392095
Name:STANSLAW, PAUL EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:STANSLAW
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:BEHAVIORAL HEALTH DEPT./ INDIAN HEALTH SERVICE
Mailing Address - Street 2:PINE RIDGE HOSPITAL/ EAST HWY 18/ PO BOX 1201
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-1201
Mailing Address - Country:US
Mailing Address - Phone:605-867-3100
Mailing Address - Fax:605-867-3274
Practice Address - Street 1:4500 EAST HWY 18 / PINE RIDGE HOSPITAL
Practice Address - Street 2:BEHAVIORAL HEALTH DEPT./ INDIAN HEALTH SERVICE
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-1201
Practice Address - Country:US
Practice Address - Phone:605-867-3100
Practice Address - Fax:605-867-3274
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2012-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ425872084P0800X
NY256385-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry