Individual
JASON TRAVIS STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3955 INDIAN RIVER BLVD STE 100, VERO BEACH, FL 32960-4800
(772) 569-2330
(772) 569-2632
Mailing address
3955 INDIAN RIVER BLVD STE 100, VERO BEACH, FL 32960-4800
(772) 569-2330
(772) 569-2630
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
ME135652
FL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
ME135652
FL
Other
Enumeration date
05/23/2013
Last updated
08/08/2021
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