Healthcare Provider Details

I. General information

NPI: 1710982525
Provider Name (Legal Business Name): JOHN M STANLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N POPE ST HMS COMMUNITY HEALTH CENTER
SILVER CITY NM
88061-5161
US

IV. Provider business mailing address

530 DEMOSS STREET HIDALGO MEDICAL SERVICES
LORDSBURG NM
88045-2618
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1511
  • Fax: 575-542-2388
Mailing address:
  • Phone: 575-542-8384
  • Fax: 575-542-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number93-161
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: