Provider Demographics
NPI:1790035954
Name:GERARD J STANLEY JR MD PC
Entity Type:Organization
Organization Name:GERARD J STANLEY JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:402-884-6700
Mailing Address - Street 1:2255 S 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2573
Mailing Address - Country:US
Mailing Address - Phone:402-884-6700
Mailing Address - Fax:402-884-6040
Practice Address - Street 1:2255 S 132ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2573
Practice Address - Country:US
Practice Address - Phone:402-884-6700
Practice Address - Fax:402-884-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026267000Medicaid
NE1427139294OtherBCBS NE
IA1427139294Medicaid
NENA2257Medicare PIN