Healthcare Provider Details

I. General information

NPI: 1447575287
Provider Name (Legal Business Name): STACEY D MCCLURE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE 4030
PHOENIX AZ
85020-2437
US

IV. Provider business mailing address

9250 N 3RD ST STE 4030
PHOENIX AZ
85020-2437
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-2271
  • Fax: 602-943-3420
Mailing address:
  • Phone: 602-944-2271
  • Fax: 602-943-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: STACEY D MCCLURE
Title or Position: MEMBER/OWNER
Credential: MD
Phone: 602-944-2271