Provider Demographics
NPI:1295772986
Name:STANMORE, ROGER DALE (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DALE
Last Name:STANMORE
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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0303
Mailing Address - Country:US
Mailing Address - Phone:256-547-6119
Mailing Address - Fax:256-546-2981
Practice Address - Street 1:7583 WALL TRIANA HWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-8327
Practice Address - Country:US
Practice Address - Phone:256-547-6119
Practice Address - Fax:256-546-2981
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51532050OtherBLUE CROSS BLUE SHIELD
AL009932569Medicaid
AL3015OtherNEIC SITE ID
AL51001283OtherBLUE CROSS BLUE SHIELD
AL3002OtherNEIC SITE ID, NSF BA0-7
AL3002OtherNEIC SITE ID, NSF BA0-7
AL3002OtherNEIC SITE ID, NSF BA0-7
AL51532050OtherBLUE CROSS BLUE SHIELD