Provider Demographics
NPI:1609875061
Name:MCFAUL, STACY LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:LYNN
Last Name:MCFAUL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:GRAYSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11995 SINGLETREE LANE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:207 DOMINION DRIVE APPLEHEAD ISLAND
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78657-7078
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH95182085B0100X, 2085R0202X
UT5392438-12042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging