MEDICARE: DONNIE R. STACY M.D.

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
1	2085R0001X	Radiation Oncology Physician	036-110971	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1659389039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNIE R. STACY M.D.

Provider Business Mailing Address
First Line	:	101 HOSPITAL BLVD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3769
Country	:	US
Telephone Number	:	812-282-3899
Fax Number	:	812-282-4172

Provider Business Practice Location Address
First Line	:	3920 S DUPONT SQ
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4615
Country	:	US
Telephone Number	:	502-721-0116
Fax Number	:	812-285-6010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	01/16/2014

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