Provider Demographics
NPI:1124124193
Name:YELL, STACEY L (MD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:YELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6060 N FOUNTAIN PLAZA DR STE 271
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7870
Mailing Address - Country:US
Mailing Address - Phone:520-229-2578
Mailing Address - Fax:520-229-2561
Practice Address - Street 1:6060 N FOUNTAIN PLAZA DR STE 271
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7870
Practice Address - Country:US
Practice Address - Phone:520-229-2578
Practice Address - Fax:520-229-2561
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ19440207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ410126Medicaid
AZ410126Medicaid