Provider Demographics
NPI:1710982525
Name:STANLEY, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:STANLEY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:530 DEMOSS STREET
Mailing Address - Street 2:HIDALGO MEDICAL SERVICES
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2618
Mailing Address - Country:US
Mailing Address - Phone:575-542-8384
Mailing Address - Fax:575-542-2388
Practice Address - Street 1:1007 N POPE ST
Practice Address - Street 2:HMS COMMUNITY HEALTH CENTER
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5161
Practice Address - Country:US
Practice Address - Phone:575-388-1511
Practice Address - Fax:575-542-2388
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2014-06-11
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Provider Licenses
StateLicense IDTaxonomies
NM93-161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF8253Medicaid
NMF8253Medicaid