Provider Demographics
NPI:1922363043
Name:PALA, STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:PALA
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 1:4180 N HWY A1A
Mailing Address - Street 2:#505
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34949-8380
Mailing Address - Country:US
Mailing Address - Phone:787-396-2110
Mailing Address - Fax:
Practice Address - Street 1:4180 N HWY A1A
Practice Address - Street 2:#505
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34949-8380
Practice Address - Country:US
Practice Address - Phone:787-396-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-040483208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice