Individual
XAVIER RAJAGOPAL STACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9205 SW BARNES RD, SUITE 20, PORTLAND, OR 97225-6603
(503) 216-2229
Mailing address
9205 SW BARNES RD, SUITE 20, PORTLAND, OR 97225-6603
(503) 216-2229
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
PG169255
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PG169255
OREGON M.D. LIMITED LICENSE
OR
Enumeration date
06/13/2014
Last updated
06/13/2014
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