Healthcare Provider Details

I. General information

NPI: 1124124193
Provider Name (Legal Business Name): STACEY L YELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 N FOUNTAIN PLAZA DR STE 271
TUCSON AZ
85704-7870
US

IV. Provider business mailing address

6060 N FOUNTAIN PLAZA DR STE 271
TUCSON AZ
85704-7870
US

V. Phone/Fax

Practice location:
  • Phone: 520-229-2578
  • Fax: 520-229-2561
Mailing address:
  • Phone: 520-229-2578
  • Fax: 520-229-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number19440
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: