Healthcare Provider Details

I. General information

NPI: 1487944336
Provider Name (Legal Business Name): STACEY A GOOD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N THIRD AVE
SANDPOINT ID
83864-1507
US

IV. Provider business mailing address

7500 RIALTO BLVD STE 1-140
AUSTIN TX
78735-8534
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-1441
  • Fax:
Mailing address:
  • Phone: 512-730-3056
  • Fax: 888-730-1925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberO1065
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: