Provider Demographics
NPI:1730128513
Name:STANLEY, WILLIAM DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
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 1:23661 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4825
Mailing Address - Country:US
Mailing Address - Phone:310-341-0188
Mailing Address - Fax:818-668-3604
Practice Address - Street 1:23661 PACIFIC COAST HWY # B
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4825
Practice Address - Country:US
Practice Address - Phone:310-341-0188
Practice Address - Fax:818-668-3604
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC153751207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2495902Medicaid
NJ457480Medicare PIN
NJ457480ZEV8Medicare PIN
NJ2495902Medicaid