Basic Information
Provider Information
NPI: 1407351836
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STANLEY
FirstName: ZACHARY
MiddleName: DAVID
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6420 CLAYTON RD STE 2701
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631171811
CountryCode: US
TelephoneNumber: 3147688873
FaxNumber: 3146468627
Practice Location
Address1: 6420 CLAYTON RD
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631171811
CountryCode: US
TelephoneNumber: 3147688873
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/27/2018
LastUpdateDate: 06/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XR4876KYN Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207V00000X2022010875MOY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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