Individual
ROBERT MICHAEL STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
675 AVENIDA DE MESILLA, LAS CRUCES, NM 88005
(505) 525-3535
(505) 527-0217
Mailing address
PO BOX 1560, LAS CRUCES, NM 88004
(505) 647-8366
(505) 647-8381
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
78268
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0761430001
DMERC
NM
01
—
16010
HMO
NM
01
—
26210
PRESBYTERIAN
NM
01
—
2666
BC BS
NM
01
—
39445593
CHAMPUS
NM
01
—
88005C005
TRICARE
NM
Enumeration date
08/23/2005
Last updated
10/29/2007
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