Healthcare Provider Details

I. General information

NPI: 1659389039
Provider Name (Legal Business Name): DONNIE R. STACY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MEDICAL CENTER DR
HAZARD KY
41701-9421
US

IV. Provider business mailing address

110 MEDICAL CENTER DR
HAZARD KY
41701-9421
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-7902
  • Fax: 606-487-7901
Mailing address:
  • Phone: 606-487-7902
  • Fax: 606-487-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036-110971
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35869-A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: