Individual
STACEY JACK MCCLARTY
Active
Individual
STACEY JACK MCCLARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD41787
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009912228
—
AL
05
—
3000170
—
TN
01
—
4160316
BLUE CROSS BLUE SHIELD OF TN
TN
05
—
5912136
—
NC
05
—
762425491A
—
GA
01
—
N394859
WELLCARE (GA MEDICAID)
GA
01
—
P00473706
MEDICARE RAILROAD
TN
Enumeration date
03/22/2007
Last updated
01/14/2010
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