Provider Demographics
NPI:1295257509
Name:STACER, BRETT J (PA)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:J
Last Name:STACER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:520 COBB ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2588
Mailing Address - Country:US
Mailing Address - Phone:231-876-6527
Mailing Address - Fax:231-876-6519
Practice Address - Street 1:96 E 120TH ST
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:MI
Practice Address - Zip Code:49327-8502
Practice Address - Country:US
Practice Address - Phone:231-834-1350
Practice Address - Fax:231-834-1355
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant