MEDICARE: DR. JAY HAROLD STANLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME25911	FL

General Provider Information

NPI Number	:	1689659658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY HAROLD STANLEY M.D.

Provider Business Mailing Address
First Line	:	3445 SADDLEBROOK LN
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3034
Country	:	US
Telephone Number	:	954-349-9521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 N PINE ISLAND RD
Second Line	:	SUITE 124
City	:	PLANTATION
State	:	FL
Zip	:	33322-5233
Country	:	US
Telephone Number	:	954-417-2608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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