Provider Demographics
NPI:1366430944
Name:STANLEY, RICHARD ALAN (DPM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 S EMERSON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2406
Mailing Address - Country:US
Mailing Address - Phone:317-784-7039
Mailing Address - Fax:317-784-7046
Practice Address - Street 1:5905 S EMERSON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2402
Practice Address - Country:US
Practice Address - Phone:317-784-7039
Practice Address - Fax:317-784-7046
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000596A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100227280Medicaid
T35029Medicare UPIN
IN796770Medicare PIN