MEDICARE: DR. MARK EDWARD STACKLE MD

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	207Q00000X	Family Medicine Physician	M8814	ID

General Provider Information

NPI Number	:	1700853678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK EDWARD STACKLE MD

Provider Business Mailing Address
First Line	:	2817 ROCK MERRITT AVE
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:	910-908-2265
Fax Number	:	910-907-8631

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVE
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-4504
Country	:	US
Telephone Number	:	910-908-2265
Fax Number	:

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	06/02/2025

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