| Organization Name: | STACEY J. CLARKE D.P.M., P.C. |
| NPI Number: | 1477680569 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STACEY J CLARKE (OWNER) |
| Mailing Address: | 1408 N Hall St La Grande |
| State: | OR US |
| Postal Code: | 978503807 |
| Phone Number: | 5419630265 |
| Fax Number: | 5419636176 |
| NPI Enumeration Date: | 02/27/2007 |
| NPI Last Update Date: | 03/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | DP00283 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |