Healthcare Provider Details

I. General information

NPI: 1114111580
Provider Name (Legal Business Name): STANLY T SELBY, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 INDUSTRIAL BLVD
ABILENE TX
79602-7929
US

IV. Provider business mailing address

1115 INDUSTRIAL BLVD
ABILENE TX
79602-7929
US

V. Phone/Fax

Practice location:
  • Phone: 325-695-4030
  • Fax: 325-695-4032
Mailing address:
  • Phone: 325-695-4030
  • Fax: 325-695-4032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG8410
License Number StateTX

VIII. Authorized Official

Name: DR. STANLY T SELBY
Title or Position: DOCTOR
Credential: M.D.
Phone: 325-695-4030