Provider Demographics
NPI:1811257165
Name:ILES, STACY E (DPM)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:E
Last Name:ILES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:ILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 3290
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-7290
Mailing Address - Country:US
Mailing Address - Phone:541-663-3100
Mailing Address - Fax:541-975-5135
Practice Address - Street 1:710 SUNSET DR STE F
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1200
Practice Address - Country:US
Practice Address - Phone:541-663-3100
Practice Address - Fax:541-975-5135
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00327200213ES0103X
ORDP186880213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery