Individual
DR. FREDERICK RICHARD STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 5TH ST, SIOUX CITY, IA 51101-1326
(712) 279-2010
(712) 279-2034
Mailing address
6909 EAST RAY ROAD #15-114, CHANDLER, AZ 85226
(520) 421-1122
(520) 421-0751
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
24459
AZ
207R00000X
Internal Medicine Physician
0002050
MT
207R00000X
Internal Medicine Physician
91977
MT
207R00000X
Internal Medicine Physician
Primary
MD-46368
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110208816
MEDICARE RAILROAD
AZ
05
—
436693002
—
AZ
01
—
AZ0866740
BLUE CROSS BLUEE SHIELD
AZ
Enumeration date
09/21/2005
Last updated
01/28/2026
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