Provider Demographics
NPI:1467461525
Name:POOL, STANLEY J
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:J
Last Name:POOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8951 RUTHBY
Mailing Address - Street 2:STE 5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-3142
Mailing Address - Country:US
Mailing Address - Phone:713-649-0041
Mailing Address - Fax:713-645-1916
Practice Address - Street 1:8951 RUTHBY
Practice Address - Street 2:STE 5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-3142
Practice Address - Country:US
Practice Address - Phone:713-649-0041
Practice Address - Fax:713-645-1916
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
033282702OtherTH STEPS
TX033282701Medicaid
TX033282701Medicaid
TX00FB66Medicare ID - Type Unspecified