Individual
DR. GEORGE BENNETT STACKHOUSE IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 JARRETT WHITE RD, TRIPLER ARMY MEDICAL CENTER, HI 96859-5001
(808) 433-6661
Mailing address
44-145 KAHINANI WAY, KANEOHE, HI 96744-2569
(301) 213-3127
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101047783
VA
208800000X
Urology Physician
04-39757
KS
208800000X
Urology Physician
G87457
CA
Other
Enumeration date
07/12/2006
Last updated
01/20/2020
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