Provider Demographics
NPI:1437340577
Name:WILLIAMS, STACEY REBECCA (DO)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:REBECCA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 GRAVIER ST
Mailing Address - Street 2:7THFLOOR, SUITE D
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 GRAVIER ST
Practice Address - Street 2:7THFLOOR, SUITE D
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2272
Practice Address - Country:US
Practice Address - Phone:504-903-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA000053207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine