Stacia Poole MD, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME51873 Issued in FL

Legal business name

STACIA POOLE MD, LLC

Practice address

930 S Harbor City Blvd
Suite 101
Melbourne, FL 32901-1963

Phone

(321) 917-8472

NPI assigned

Jul 21, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stacia Poole, MD

Title

Owner

Phone

(321) 917-8472

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437436800000",
    "number": "1467837476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 S HARBOR CITY BLVD",
            "address_2": "SUITE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011963",
            "telephone_number": "321-917-8472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 S HARBOR CITY BLVD",
            "address_2": "SUITE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011963",
            "telephone_number": "321-917-8472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACIA POOLE MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-21",
        "last_updated": "2015-07-21",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "STACIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-917-8472",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME51873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.