# JOHN DOUGLAS STACEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1285070474
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | O-0808 | ID | — |
| 207X00000X | Orthopaedic Surgery Physician | OT017816 | PA | Yes |
| 208D00000X | General Practice Physician | O-0808 | ID | — |

## Other

- **Enumeration date:** 05/15/2013
- **Last updated:** 04/06/2026