Provider Demographics
NPI:1639128424
Name:STANLEY, RICHARD E (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
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 1:423 MEDICAL PARK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5640
Mailing Address - Country:US
Mailing Address - Phone:865-271-6600
Mailing Address - Fax:865-271-6601
Practice Address - Street 1:423 MEDICAL PARK DR
Practice Address - Street 2:STE 100
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5640
Practice Address - Country:US
Practice Address - Phone:865-271-6600
Practice Address - Fax:865-271-6601
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD11748OtherMD LICENSE
TN4118946OtherBCBS
TN4118946OtherBCBS
TN3178869Medicare ID - Type Unspecified