MEDICARE: STANLY T SELBY, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G8410	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00DR62	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1114111580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANLY T SELBY, M.D.

Provider Business Mailing Address
First Line	:	1115 INDUSTRIAL BLVD
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79602-7929
Country	:	US
Telephone Number	:	325-695-4030
Fax Number	:	325-695-4032

Provider Business Practice Location Address
First Line	:	1115 INDUSTRIAL BLVD
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79602-7929
Country	:	US
Telephone Number	:	325-695-4030
Fax Number	:	325-695-4032

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. STANLY T SELBY
Credential	:	M.D.
Telephone Number	:	325-695-4030

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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