Provider Demographics
NPI:1689646168
Name:STANLEY, MATTHEW B (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5700
Practice Address - Fax:605-322-5704
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD39642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN040121002OtherPRIMEWEST
IA3148379Medicaid
SD370624200OtherDEPT OF LABOR
NE46022474352Medicaid
SD25054OtherARAZ/ AMERICA'S PPO
SD7100963Medicaid
ND12200Medicaid
MN241L8STOtherCC SYSTEMS/ BLUE PLUS
SD6438OtherMIDLANDS CHOICE
SDHP32074OtherHEALTHPARTNERS
SD412991017061OtherPREFERRED ONE
SD57108C021OtherWPS TRICARE
SD3964OtherDAKOTACARE
MN619014600Medicaid
SD23018OtherSANFORD HEALTH PLAN
SD4995812OtherBLUE CROSS
MN619014600Medicaid
NE46022474352Medicaid