Provider Demographics
NPI:1922028646
Name:STANLEY, RONALD TRUETT (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:TRUETT
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 1:106 HODGE STREET
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482
Mailing Address - Country:US
Mailing Address - Phone:903-885-2911
Mailing Address - Fax:903-335-8739
Practice Address - Street 1:106 HODGE STREET
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482
Practice Address - Country:US
Practice Address - Phone:903-885-2911
Practice Address - Fax:903-335-8739
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC12276Medicare UPIN
TX8E0223Medicare ID - Type Unspecified