Individual
DR. STACEY RAYBUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 WESTPARK DR, BRENTWOOD, TN 37027-5031
(910) 310-4551
Mailing address
3250 N PIEDRA CIR, MESA, AZ 85207-0809
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
008112
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102413281
—
PA
05
—
767741
—
AZ
Enumeration date
06/12/2006
Last updated
05/19/2023
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