Provider Demographics
NPI:1992843031
Name:ALEXANDER, STANLEY LAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LAKE
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4116 SPRINGBORO RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9607
Mailing Address - Country:US
Mailing Address - Phone:513-932-2604
Mailing Address - Fax:
Practice Address - Street 1:15 IRONGATE PARK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-4616
Practice Address - Country:US
Practice Address - Phone:937-439-5500
Practice Address - Fax:937-439-5375
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038388A208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Not Answered2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand