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Individual
DR. FREDERICK RICHARD STACK
Active
Individual
DR. FREDERICK RICHARD STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
24459
AZ
207R00000X
Internal Medicine Physician
0002050
MT
207R00000X
Internal Medicine Physician
91977
MT
207R00000X
Internal Medicine Physician
Primary
MD-46368
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110208816
MEDICARE RAILROAD
AZ
05
—
436693002
—
AZ
01
—
AZ0866740
BLUE CROSS BLUEE SHIELD
AZ
Enumeration date
09/21/2005
Last updated
01/28/2026
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