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: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 S DUPONT SQ
LOUISVILLE KY
40207-4615
US

IV. Provider business mailing address

101 HOSPITAL BLVD
JEFFERSONVILLE IN
47130-3769
US

V. Phone/Fax

Practice location:
  • Phone: 502-721-0116
  • Fax: 812-285-6010
Mailing address:
  • Phone: 812-282-3899
  • Fax: 812-282-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036-110971
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: