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General NPI Number Information
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NPI Number | 1144332529
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Entity Type | Organization
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Legal Business Name | KENNETH J STANLEY MD PA
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 10100 BROADWAY ST SUITE 110
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City | PEARLAND
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State | TX
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Zip | 77584-8425
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Country | US
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Telephone | 713-436-8501
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Fax | 713-436-8563
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Provider Business Mailing Address
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Address Line | 10223 BROADWAY ST SUITE P335
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City | PEARLAND
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State | TX
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Zip | 77584-7880
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Country | US
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Telephone | 713-436-8501
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Fax | 713-436-8563
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH J STANLEY
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Credential | M.D.
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Telephone | 713-436-8501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L2014
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License Number State | TX
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