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General NPI Number Information
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NPI Number | 1356797740
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Entity Type | Individual
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Provider Name | RUSSELL FOREST STANLEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 1100 E LAKE ST STE 260
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City | TYLER
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State | TX
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Zip | 75701-3359
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Country | US
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Telephone | 903-590-5700
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Fax | 903-590-5735
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Provider Business Mailing Address
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Address Line | PO BOX 846098
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City | DALLAS
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State | TX
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Zip | 75284-6098
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Country | US
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Telephone | 903-606-6400
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Fax | 903-606-1522
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | S0996
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | DO.2123
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 2123
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | S0996
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License Number State | TX
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