Healthcare Provider Details

I. General information

NPI: 1003896168
Provider Name (Legal Business Name): DAVID L STANBERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 E HOWARD ST
WILLARD OH
44890-1656
US

IV. Provider business mailing address

388 E HOWARD ST
WILLARD OH
44890-1656
US

V. Phone/Fax

Practice location:
  • Phone: 419-935-8120
  • Fax:
Mailing address:
  • Phone: 419-935-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35047100
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: