Provider Demographics
NPI:1922322486
Name:STACY, MARK ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:STACY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3630 GUION RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1616
Mailing Address - Country:US
Mailing Address - Phone:317-920-7280
Mailing Address - Fax:317-920-7284
Practice Address - Street 1:3630 GUION RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1616
Practice Address - Country:US
Practice Address - Phone:317-920-7280
Practice Address - Fax:317-920-7284
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11015131A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology