Individual
JACK LEROY STCLAIR
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14540 MONO WAY, SONORA, CA 95370-8858
(209) 743-7084
(209) 928-5615
Mailing address
PO BOX 4264, SONORA, CA 95370-4264
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
A76427
CA
Other
Enumeration date
05/01/2006
Last updated
07/08/2007
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