Provider Demographics
NPI:1447575287
Name:STACEY D MCCLURE MD PLLC
Entity Type:Organization
Organization Name:STACEY D MCCLURE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-944-2271
Mailing Address - Street 1:9250 N 3RD ST
Mailing Address - Street 2:STE 4030
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2437
Mailing Address - Country:US
Mailing Address - Phone:602-944-2271
Mailing Address - Fax:602-943-3420
Practice Address - Street 1:9250 N 3RD ST
Practice Address - Street 2:STE 4030
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2437
Practice Address - Country:US
Practice Address - Phone:602-944-2271
Practice Address - Fax:602-943-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty