Provider Demographics
NPI:1740393784
Name:EILERS, STANLEY G (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:G
Last Name:EILERS
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 1:1911 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5320
Mailing Address - Country:US
Mailing Address - Phone:319-366-1503
Mailing Address - Fax:319-366-6976
Practice Address - Street 1:1911 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5320
Practice Address - Country:US
Practice Address - Phone:319-366-1503
Practice Address - Fax:319-366-6976
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26487207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0258749Medicaid
IA0258749Medicaid
IA00241Medicare ID - Type Unspecified