Active NPI
Stanley Self, MD
- Forensic Psychiatry Physician
- Rusk, TX
National Provider Identifier
1902946916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychiatry Physician
- License
- H4693
- Practice address
- 1601 North Dickinson Drive
Rusk, TX 75785 - Phone
- (903) 683-3421
- NPI assigned
- Feb 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Forensic Psychiatry Physician | 2084F0202X | H4693 | TX | Primary |
Addresses
Primary practice location
1601 North Dickinson Drive
Rusk, TX 75785
Mailing address
17844 Sunset Strip
Flint, TX 75762-9447
Phone (903) 683-3421
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H4693 | TX | MD | Forensic Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902946916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17844 SUNSET STRIP",
"city": "FLINT",
"state": "TX",
"postal_code": "757629447",
"telephone_number": "903-683-3421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 NORTH DICKINSON DRIVE",
"city": "RUSK",
"state": "TX",
"postal_code": "75785",
"telephone_number": "903-683-3421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELF",
"first_name": "STANLEY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084F0202X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Forensic Psychiatry",
"state": "TX",
"license": "H4693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rusk, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.