Individual
JONATHAN EDMUND STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
527 MEDICAL PARK DR STE 302, BRIDGEPORT, WV 26330-9009
(681) 342-3870
(304) 842-7650
Mailing address
527 MEDICAL PARK DR STE 302, BRIDGEPORT, WV 26330-9009
(681) 342-3870
(304) 842-7650
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
WVDO2347
WV
207RI0200X
Infectious Disease Physician
Primary
2347
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/11/2007
Last updated
04/05/2022
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