Clark, Stacey Leigh
Clark, Stacey Leigh is an individual health care provider with primary practice located at 3705 Medical Pkwy Suite 200, Austin TX 78705-1019. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Otolaryngology, which is considered as her primary health care specialty. Clark, Stacey Leigh can be contacted via phone (512) 324-2720.Contact Information
Primary practice address
3705 Medical Pkwy Suite 200
Austin TX 78705-1019
Phone: (512) 324-2720
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Otolaryngology | 207YP0228X | N9190 | Texas |
Profile Details
| NPI number | 1184808511 |
|---|---|
| LBN Legal business name | Clark, Stacey Leigh |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 20th, 2007 |
| Last updated | Jan 30th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184808511 | NPPES |
| Texas | MEDICAID | 285628801 | |
| Texas | MEDICAID | 285628802 |
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