Organization
BOONE DERMATOLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD J STANLEY MD (PRESIDENT)
(828) 264-4553
Entity
Organization
Contact information
Practice address
169 BIRCH ST, BOONE, NC 28607-5069
(828) 264-4553
(828) 262-3649
Mailing address
169 BIRCH ST, BOONE, NC 28607-5069
(828) 264-4553
(828) 262-3649
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
18060
NC
207N00000X
Dermatology Physician
200000665
NC
207N00000X
Dermatology Physician
200500862
NC
207N00000X
Dermatology Physician
25707
NC
207N00000X
Dermatology Physician
Primary
39986
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01404
BLUE CROSS BLUE SHIELD
NC
05
—
8901404
—
NC
Enumeration date
04/21/2006
Last updated
04/13/2015
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