Individual
JOANNA STACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-4404
(254) 724-2111
(254) 724-7603
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
N1904
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010079128
—
VA
05
—
010079136
—
VA
05
—
1093781569
—
VA
Enumeration date
02/24/2006
Last updated
10/30/2020
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