Provider Demographics
NPI:1639336746
Name:STANLEY, RUSSELL (DPM)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12450 NETWORK BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3466
Mailing Address - Country:US
Mailing Address - Phone:210-899-1026
Mailing Address - Fax:210-314-3632
Practice Address - Street 1:8122 DATAPOINT DR STE 700
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3444
Practice Address - Country:US
Practice Address - Phone:210-899-1026
Practice Address - Fax:210-692-0805
Is Sole Proprietor?:No
Enumeration Date:2008-05-18
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1853213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery