Provider Demographics
NPI:1215000930
Name:STACY, ELMER JOE (RRT,CRTT,RCP)
Entity Type:Individual
Prefix:
First Name:ELMER
Middle Name:JOE
Last Name:STACY
Suffix:
Gender:M
Credentials:RRT,CRTT,RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-5306
Mailing Address - Country:US
Mailing Address - Phone:361-229-1696
Mailing Address - Fax:361-758-3339
Practice Address - Street 1:1010 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-5306
Practice Address - Country:US
Practice Address - Phone:361-229-1696
Practice Address - Fax:361-758-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider