Individual
GARY STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4310 COLBY AVE, SUITE 203, EVERETT, WA 98203-2338
(425) 252-8102
Mailing address
4310 COLBY AVE, SUITE 203, EVERETT, WA 98203-2338
(425) 252-8102
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD00012487
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0050032
LABOR AND INDUSTRY
WA
05
—
1067305
—
WA
01
—
MD00012487
STATE LICENSE NUMBER
WA
Enumeration date
06/07/2006
Last updated
01/12/2008
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