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:
Health care specialties
| Specialty | Code | License # | 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 last year |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548256977 | NPPES |
| Arizona | MEDICAID | 436693002 | |
| Arizona | Other | AZ0866740 | |
| Arizona | Other | 110208816 |
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