Provider Demographics
NPI:1265418032
Name:STANLEY, DAVID GRANVILLE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GRANVILLE
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 1:988 OAK RIDGE TPKE
Mailing Address - Street 2:PHYSICIANS PLAZA, STE 350
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6930
Mailing Address - Country:US
Mailing Address - Phone:865-483-7030
Mailing Address - Fax:865-483-3954
Practice Address - Street 1:988 OAK RIDGE TPKE
Practice Address - Street 2:PHYSICIANS PLAZA, STE 350
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6930
Practice Address - Country:US
Practice Address - Phone:865-483-7030
Practice Address - Fax:865-483-3954
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD004672208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB02128Medicare UPIN
TN3145544Medicare ID - Type Unspecified