Individual
STANLEY R STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10106 S SHERIDAN RD, TULSA, OK 74133-6775
(918) 619-9400
Mailing address
10106 S SHERIDAN RD, TULSA, OK 74133-6775
(918) 230-9164
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
3054
OK
208D00000X
General Practice Physician
3054
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100096630A
—
OK
Enumeration date
01/19/2006
Last updated
08/22/2023
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