Basic Information
| Provider Information | |||||||||
| NPI: | 1427139294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANLEY | ||||||||
| FirstName: | GERARD | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7710 MERCY RD STE 224 | ||||||||
| Address2: | ATTN: LISA TERRY | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681242346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023615225 | ||||||||
| FaxNumber: | 4023911533 | ||||||||
| Practice Location | |||||||||
| Address1: | 2255 S 132ND ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681442573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028846700 | ||||||||
| FaxNumber: | 4025028202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2006034640 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 23704 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1427139294 | 01 | NE | BC/BS NEBRASKA | OTHER | 100262670-00 | 05 | NE | MEDICAID | 1427139294 | 05 | IA | MEDICAID |