Provider Demographics
NPI:1902808629
Name:ROUS, STANLEY M (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:M
Last Name:ROUS
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:P.O. BOX 39209
Mailing Address - Street 2:
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339
Mailing Address - Country:US
Mailing Address - Phone:954-851-9966
Mailing Address - Fax:954-318-7360
Practice Address - Street 1:850 S. PINE ISLAND RD.
Practice Address - Street 2:STE. A 100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-741-5555
Practice Address - Fax:954-741-6298
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0024739174400000X
FLME24739207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202266OtherAVMED
FL93031OtherBLUE CROSS BLUE SHEILD
FL054319500Medicaid
FL180024797OtherRAILROAD MEDICARE
FL202266OtherCOMPBENEFITS CORPORATION
FL650560968OtherUNITED
FL2457357OtherAETNA
FL650560968OtherCIGNA
FL650560968OtherHUMANA
FL054319500Medicaid
FL93031XMedicare PIN