Provider Demographics
NPI:1669404992
Name:MOUNTS, STANLEY A (DO)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:A
Last Name:MOUNTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1701 W 26TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1513
Mailing Address - Country:US
Mailing Address - Phone:417-627-8967
Mailing Address - Fax:417-627-8920
Practice Address - Street 1:2727 MC CLELLAND BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1626
Practice Address - Country:US
Practice Address - Phone:417-625-2300
Practice Address - Fax:417-625-2005
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOR1F87207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD41558Medicare UPIN