Provider Demographics
NPI:1427139294
Name:STANLEY, GERARD JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:JOSEPH
Last Name:STANLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 MERCY RD STE 224
Mailing Address - Street 2:ATTN: LISA TERRY
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2346
Mailing Address - Country:US
Mailing Address - Phone:402-361-5225
Mailing Address - Fax:402-391-1533
Practice Address - Street 1:2255 S 132ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2573
Practice Address - Country:US
Practice Address - Phone:402-884-6700
Practice Address - Fax:402-502-8202
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034640207Q00000X
NE23704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1427139294OtherBC/BS NEBRASKA
NE100262670-00Medicaid
IA1427139294Medicaid
NENA2257Medicare PIN
NE100262670-00Medicaid
IA1427139294Medicaid