Individual
DR. JACK ROBERT STACEY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 MERCY CIRCLE, OCEANSIDE, CA 92055
(760) 725-0456
Mailing address
2616 CABRILLO PL, CARLSBAD, CA 92008-1436
(321) 278-3667
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
0101271348
VA
Other
Enumeration date
03/23/2017
Last updated
02/06/2025
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