Individual
DR. JAY M STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
705 E MARSHALL AVE, LONGVIEW, TX 75601-5573
(903) 315-2000
Mailing address
700 E MARSHALL AVE, LONGVIEW, TX 75601-5580
(903) 315-2000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
29485
OK
207X00000X
Orthopaedic Surgery Physician
Primary
N6040
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214084005
—
TX
01
—
P02587354
MEDICARE RAILROAD
TX
Enumeration date
12/20/2007
Last updated
01/21/2021
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