Provider Demographics
NPI:1740349836
Name:WHISENANT, STANLEY W (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:W
Last Name:WHISENANT
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 1:2931 RIDGE RD STE 101-159
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6670
Mailing Address - Country:US
Mailing Address - Phone:945-766-4457
Mailing Address - Fax:972-777-9939
Practice Address - Street 1:4000 WESLEY ST STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-9015
Practice Address - Country:US
Practice Address - Phone:945-766-4457
Practice Address - Fax:972-777-9939
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7725207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX92272OtherAVAILITY
TXJ7725OtherTEX MEDICAL LICENSE
TX0053MTOtherBCBS TX
TX688993OtherAMBETTER
TX8AE000OtherBCBS TX
TX395576OtherWELLCARE