Provider Demographics
NPI:1861415697
Name:STANLEY, RICK DEAN (MD)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:DEAN
Last Name:STANLEY
Suffix:
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 1:832 ELM ST SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2062
Mailing Address - Country:US
Mailing Address - Phone:541-812-5820
Mailing Address - Fax:541-812-5821
Practice Address - Street 1:832 ELM ST SW
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2062
Practice Address - Country:US
Practice Address - Phone:541-812-5820
Practice Address - Fax:541-812-5821
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11115174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR261305Medicaid
ORD72855Medicare UPIN
OR00000BKBJMMedicare ID - Type Unspecified