Clarke, Stacey J

Clarke, Stacey J is an individual health care provider with primary practice located at 1408 N Hall St , La Grande OR 97850-3807. She recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as her primary health care specialty. Clarke, Stacey J can be contacted via phone (541) 963-0265.

Contact Information

Primary practice address
1408 N Hall St La Grande OR 97850-3807
Phone: (541) 963-0265
Fax: (541) 963-6176
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X DP00283 Oregon

Profile Details

NPI number 1437157260
LBN Legal business name Clarke, Stacey J
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2005
Last updated Oct 10th, 2017 - about 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437157260 NPPES
Oregon MEDICAID 150541

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