Individual
STACEY W. WING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
610 PROVIDENCE PARK DR E, BLDG 1 - SUITE 102, MOBILE, AL 36695-4622
(251) 378-3900
(251) 378-3901
Mailing address
PO BOX 850489, MOBILE, AL 36685-0489
(251) 342-3949
(251) 631-3361
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21251
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117354
—
AL
01
—
511-01630
BLUE CROSS BLUE SHIELD
AL
Enumeration date
05/25/2006
Last updated
02/03/2011
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