Individual
DR. STACEY LEIGH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3705 MEDICAL PKWY, SUITE 200, AUSTIN, TX 78705-1019
(512) 324-2720
Mailing address
3705 MEDICAL PKWY, SUITE 200, AUSTIN, TX 78705-1019
(512) 324-2720
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
N9190
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
285628801
—
TX
05
—
285628802
—
TX
Enumeration date
12/20/2007
Last updated
01/30/2012
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