Basic Information
| Provider Information | |||||||||
| NPI: | 1659397677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANLEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4140 W. MEMORIAL RD | ||||||||
| Address2: | STE 321 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731208300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057484726 | ||||||||
| FaxNumber: | 4056078497 | ||||||||
| Practice Location | |||||||||
| Address1: | 4140 W. MEMORIAL RD | ||||||||
| Address2: | STE 321 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731208300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057484726 | ||||||||
| FaxNumber: | 4056078497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 01/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 18898 | OK | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100825450B | 05 | OK | MEDICAID | 248414703 | 01 | OK | MEDICARE | OTHER |