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Individual

DR. STACY LAUREN COULTHARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
BROOKE ARMY MEDICAL CENTER, 3551 ROGER BROOKE DRIVE, JBSA FORT SAM HOUSTON, TX 78234-4505
(210) 916-5102
Mailing address
BROOKE ARMY MEDICAL CENTER, 3551 ROGER BROOKE DRIVE, JBSA FORT SAM HOUSTON, TX 78234-4505
(210) 916-5102

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101246005
VA
208600000X
Surgery Physician
Primary
0101246005
VA
2086S0102X
Surgical Critical Care Physician
MD480489
PA
2086S0127X
Trauma Surgery Physician
MD480489
PA

Other

Enumeration date
06/11/2008
Last updated
08/06/2025
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