Provider Demographics
NPI:1740645274
Name:J HAROLD STANLEY MD PA
Entity type:Organization
Organization Name:J HAROLD STANLEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-473-4108
Mailing Address - Street 1:1776 N PINE ISLAND RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5233
Mailing Address - Country:US
Mailing Address - Phone:954-473-4108
Mailing Address - Fax:
Practice Address - Street 1:1776 N PINE ISLAND ROAD
Practice Address - Street 2:SUITE 124
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322
Practice Address - Country:US
Practice Address - Phone:954-473-4108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1779332H00000X
FLME25911332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030403191OtherNPI 11#
FL030403191OtherNPI 11#