Individual
STACY RENE MCCARTY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
939 OAK ST SE, SALEM, OR 97301-3901
(503) 561-5200
Mailing address
PO BOX 13129, SALEM, OR 97309-1129
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
2007022061
MO
207V00000X
Obstetrics & Gynecology Physician
Primary
MD152435
OR
Other
Enumeration date
03/16/2007
Last updated
11/10/2020
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