Provider Demographics
NPI:1154857985
Name:GILMORE, STACIE (MD)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 LEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6213
Mailing Address - Country:US
Mailing Address - Phone:828-837-4712
Mailing Address - Fax:828-837-4808
Practice Address - Street 1:183 LEDFORD ST
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6213
Practice Address - Country:US
Practice Address - Phone:828-837-4712
Practice Address - Fax:828-837-4808
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201902478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine