Stack, Gary

Stack, Gary is an individual health care provider with primary practice located at 4310 Colby Ave Suite 203, Everett WA 98203-2338. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Stack, Gary can be contacted via phone (425) 252-8102.

Contact Information

Primary practice address
4310 Colby Ave Suite 203 Everett WA 98203-2338
Phone: (425) 252-8102
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X MD00012487 Washington

Profile Details

NPI number 1487694535
LBN Legal business name Stack, Gary
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 7th, 2006
Last updated Jan 12th, 2008 - about 16 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 1487694535 NPPES
Washington Other 0050032 LABOR AND INDUSTRY
Washington MEDICAID 1067305 LABOR AND INDUSTRY
Washington Other MD00012487 LABOR AND INDUSTRY

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