Individual
BRENDAN CURRAN STACK JR.
Active
Individual
BRENDAN CURRAN STACK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
E4564
AR
207YS0123X
Facial Plastic Surgery Physician
E4564
AR
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
036-151806
IL
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
E-4564
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0507002300
QUALCHOICE
AR
05
—
158045001
—
AR
01
—
5N281
BCBS
AR
01
—
5N2817666
ADDITIONAL MEDICARE
—
01
—
E4564
MEDICAL LICENSE
AR
01
—
T2005-275
TRICARE
AR
Enumeration date
08/01/2006
Last updated
02/19/2020
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