Individual
DERICK STACKPOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4035 ELECTRIC RD STE A, ROANOKE, VA 24018
(540) 772-8670
Mailing address
4035 ELECTRIC RD STE A, ROANOKE, VA 24018-8449
(540) 772-8670
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110006532
VA
Other
Enumeration date
12/30/2018
Last updated
08/29/2019
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