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General NPI Number Information
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NPI Number | 1528038494
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Entity Type | Individual
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Provider Name | MARK WILLARD STANLEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 793 W STATE ST
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City | COLUMBUS
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State | OH
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Zip | 43222-1551
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Country | US
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Telephone | 614-552-0061
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Fax | 614-552-0168
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Provider Business Mailing Address
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Address Line | 12941 STONECREEK DR UNIT A
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City | PICKERINGTON
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State | OH
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Zip | 43147-8424
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Country | US
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Telephone | 614-552-0061
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Fax | 614-552-0168
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 34-00-7528S
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License Number State | OH
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