Individual
DR. VINCE J STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 W 16TH ST, SALIDA, CO 81201-2240
(719) 539-6112
Mailing address
PO BOX 2153 DEPT 40339, BIRMINGHAM, AL 35287-9387
(423) 310-1642
(706) 270-0487
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
46814
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45604771
—
CO
Enumeration date
05/16/2006
Last updated
02/03/2023
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