Individual
GINA L STALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1025 HEATHER CT, REEDSPORT, OR 97467-1919
(541) 361-0121
Mailing address
1025 HEATHER CT, REEDSPORT, OR 97467-1919
(541) 361-0121
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5871
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5871
LICENSE
OR
Enumeration date
12/12/2008
Last updated
12/12/2008
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