Healthcare Provider Details

I. General information

NPI: 1023088986
Provider Name (Legal Business Name): MICHAEL D STANLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E PRESIDENT GEORGE BUSH HWY SUITE 250
RICHARDSON TX
75082-3542
US

IV. Provider business mailing address

3412 CLEAR FORK TRL
FORT WORTH TX
76109-2409
US

V. Phone/Fax

Practice location:
  • Phone: 972-437-5099
  • Fax:
Mailing address:
  • Phone: 817-763-0945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberF7930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: