Provider Demographics
NPI:1639370588
Name:DOUGLAS S. STANLEY, M.D., INC.
Entity Type:Organization
Organization Name:DOUGLAS S. STANLEY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-447-9027
Mailing Address - Street 1:7780 N FRESNO ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2413
Mailing Address - Country:US
Mailing Address - Phone:559-447-9027
Mailing Address - Fax:559-447-1675
Practice Address - Street 1:7780 N FRESNO ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2413
Practice Address - Country:US
Practice Address - Phone:559-447-9027
Practice Address - Fax:559-447-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71417174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH61963Medicare UPIN