Individual
IAN STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
35 MEMORIAL DR, PINEHURST, NC 28374-8708
(910) 715-7856
Mailing address
126 JAMES CREEK RD, SOUTHERN PINES, NC 28387-6819
(910) 692-8224
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
103480
NC
Other
Enumeration date
02/29/2008
Last updated
02/29/2008
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