| Doctor Name: | JACK LEROY STCLAIR |
| NPI Number: | 1184681298 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | A76427 |
| Business Practice Address: | 14540 Mono Way Sonora, CA - 953708858 |
| Business Phone Number: | 2097437084 |
| Business Fax Number: | 2099285615 |
| Mailing Address: | Po Box 4264, SONORA |
| State: | CA |
| Postal Code: | 953704264 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | A76427 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |