Individual
RICHARD ROBERT STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6403 COYLE AVE, SUITE 450, CARMICHAEL, CA 95608-0311
(916) 482-7621
(916) 972-7734
Mailing address
3637 MISSION AVE, SUITE 7, CARMICHAEL, CA 95608-2946
(916) 482-7621
(916) 972-7734
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
G54291
CA
207RI0200X
Infectious Disease Physician
G54291
CA
207RP1001X
Pulmonary Disease Physician
Primary
G54291
CA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
G54291
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G542910
—
CA
Enumeration date
06/12/2006
Last updated
01/17/2013
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