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General NPI Number Information
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NPI Number | 1467089888
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Entity Type | Individual
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Provider Name | PETER JOHN STACY DO
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Gender | Male
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 18230 SILVER CREEK STREET BUILDING 392, MDG, SOUTH
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City | BUCKLEY SFB
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State | CO
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Zip | 80011
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Country | US
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Telephone | 720-847-6451
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Fax |
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Provider Business Mailing Address
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Address Line | 5427 EAST MADERA ST BUILDING 4339
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City | DAVIS MONTHAN AFB
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State | AZ
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Zip | 85707
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Country | US
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Telephone | 520-228-4357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2022038659
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License Number State | MO
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