Provider Demographics
NPI:1417111576
Name:CAMPO, STACIE LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:LEIGH
Last Name:CAMPO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 7817
Mailing Address - Street 2:MISSOULA SURGICAL ASSOCIATES
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807
Mailing Address - Country:US
Mailing Address - Phone:406-542-7525
Mailing Address - Fax:406-829-0661
Practice Address - Street 1:2819 GREAT NORTHERN LOOP STE 200
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1750
Practice Address - Country:US
Practice Address - Phone:406-542-7525
Practice Address - Fax:406-829-0661
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2023-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT12755208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1417111576Medicaid