Provider Demographics
NPI:1740207273
Name:STANLEY, SAMUEL LEONARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LEONARD
Last Name:STANLEY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:C B 8221
Mailing Address - Street 2:7425 FORSYTH
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2161
Mailing Address - Country:US
Mailing Address - Phone:314-747-3000
Mailing Address - Fax:314-747-4511
Practice Address - Street 1:660 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-747-3000
Practice Address - Fax:314-747-4511
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-01-14
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Provider Licenses
StateLicense IDTaxonomies
MOR5D11207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A27696Medicare UPIN