Individual
STACY DIANE OSTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
875 E PLAZA DR STE 103, EAGLE, ID 83616-6549
(208) 229-7075
Mailing address
PO BOX 434, EAGLE, ID 83616-0434
(208) 229-7075
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
M-9953
ID
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
A68685
CA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
MD00049170
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M-9953
IDAHO MEDICAL LICENSE
ID
Enumeration date
02/01/2006
Last updated
04/21/2011
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