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NPI Code Detail

MEDICARE: DR. STACEY J PORTERFIELD DO

MEDICARE: DR. STACEY J PORTERFIELD DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianDO200874OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255300992
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACEY J PORTERFIELD DO
Provider Business Mailing Address
First Line : 1000 E MAIN ST
Second Line :
City : MEDFORD
State : OR
Zip : 97504-7667
Country : US
Telephone Number : 541-773-3863
Fax Number : 541-776-2892
Provider Business Practice Location Address
First Line : 8385 DIVISION RD
Second Line :
City : WHITE CITY
State : OR
Zip : 97503-1176
Country : US
Telephone Number : 541-826-5853
Fax Number : 541-826-5843
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2006
Last Update Date : 07/09/2021

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