Healthcare Provider Details

I. General information

NPI: 1750136966
Provider Name (Legal Business Name): STACY PLOOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 E 22ND ST
TUCSON AZ
85710-8509
US

IV. Provider business mailing address

7901 E 22ND ST
TUCSON AZ
85710-8509
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-8888
  • Fax: 520-694-8466
Mailing address:
  • Phone: 520-694-8888
  • Fax: 520-694-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number57.261137
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR80826
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: