Individual
JERREL L STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
N112 W 17975 MEQUON ROAD, GERMANTOWN, WI 53022
(262) 532-7600
(262) 532-7602
Mailing address
3003 W GOOD HOPE ROAD, MILWAUKEE, WI 53209
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22544
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30387500
—
WI
01
—
P00451316
RR MEDICARE
WI
Enumeration date
07/10/2006
Last updated
12/29/2010
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