Individual
STACY MCBROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2016 OAK PARK BLVD, LAKE CHARLES, LA 70601-7828
(337) 477-8861
(337) 477-3092
Mailing address
PO BOX 122525, DEPT 2525, DALLAS, TX 75312-2525
(337) 494-2772
(337) 494-2928
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
DO000034
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1318540
—
LA
Enumeration date
07/17/2006
Last updated
02/15/2021
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