Basic Information
| Provider Information | |||||||||
| NPI: | 1922072016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | KEITH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4140 FERNCREEK DR | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283142563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104842171 | ||||||||
| FaxNumber: | 9104844568 | ||||||||
| Practice Location | |||||||||
| Address1: | 4140 FERNCREEK DR | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283142563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104842171 | ||||||||
| FaxNumber: | 9104844568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 12/09/2015 | ||||||||
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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 | 207X00000X | 25025 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD.207799 | LA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1304484 | 05 | LA | MEDICAID | 8935462 | 05 | NC | MEDICAID | 08473255 | 05 | MS | MEDICAID | 35462 | 01 | NC | BCBS INDIVIDUAL ID NUMBER | OTHER |