Individual
STANFORD T ISRAELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
508 STOCKTRAIL AVE, SUITE A, GILLETTE, WY 82716-3582
(307) 686-1413
Mailing address
508 STOCKTRAIL AVE, SUITE A, GILLETTE, WY 82716-3582
(307) 686-1413
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
9750A
WY
Other
Enumeration date
08/08/2008
Last updated
08/13/2014
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