Individual
KEVIN B STACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
864 PRESTON RD, DENISON, TX 75020-0775
(903) 624-6514
(903) 709-0104
Mailing address
864 PRESTON RD, DENISON, TX 75020-0775
(903) 624-6514
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K7908
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102719507
—
TX
01
—
8A9554
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/25/2006
Last updated
05/30/2024
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