Organization
STACEY J. CLARKE DPM, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACEY J CLARKE DPM (OWNER)
(541) 963-0265
Entity
Organization
Contact information
Practice address
1408 N HALL ST, LA GRANDE, OR 97850-3807
(541) 963-0265
(541) 963-6176
Mailing address
1408 N HALL ST, LA GRANDE, OR 97850-3807
(541) 963-0265
(541) 963-6176
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DP00283
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150541
—
OR
Enumeration date
03/05/2007
Last updated
08/22/2020
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