Basic Information
| Provider Information | |||||||||
| NPI: | 1790035954 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GERARD J STANLEY JR MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2255 S 132ND ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681442573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028846700 | ||||||||
| FaxNumber: | 4028846040 | ||||||||
| Practice Location | |||||||||
| Address1: | 2255 S 132ND ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681442573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028846700 | ||||||||
| FaxNumber: | 4028846040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2012 | ||||||||
| LastUpdateDate: | 03/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | STANLEY | ||||||||
| AuthorizedOfficialFirstName: | GERARD | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4028846700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10026267000 | 05 | NE | MEDICAID | 1427139294 | 01 | NE | BCBS NE | OTHER | 1427139294 | 05 | IA | MEDICAID |