Provider Demographics
NPI:1699763797
Name:WEN, STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:WEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:14419 W MCDOWELL RD
Mailing Address - Street 2:SUITE E-102
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2511
Mailing Address - Country:US
Mailing Address - Phone:623-535-3857
Mailing Address - Fax:623-535-4310
Practice Address - Street 1:14419 W MCDOWELL RD
Practice Address - Street 2:SUITE E-102
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2511
Practice Address - Country:US
Practice Address - Phone:623-535-3857
Practice Address - Fax:623-535-4310
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ32983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ127666Medicare PIN