Stack, Frederick Richard

Stack, Frederick Richard is an sole proprietor health care provider with primary practice located at 801 5Th St , Sioux City IA 51101-1326. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Stack, Frederick Richard can be contacted via phone (712) 279-2010.

Contact Information

Primary practice address
801 5Th St Sioux City IA 51101-1326
Phone: (712) 279-2010
Fax: (712) 279-2034
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 24459 Arizona
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 0002050 Montana
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD-46368 Iowa

Profile Details

NPI number 1548256977
LBN Legal business name Stack, Frederick Richard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 21st, 2005
Last updated Jul 10th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548256977 NPPES
Arizona MEDICAID 436693002
Arizona Other AZ0866740
Arizona Other 110208816

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