Gary Stack, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD00012487 Issued in WA

Practice address

4310 Colby Ave
Suite 203
Everett, WA 98203-2338

Phone

(425) 252-8102

NPI assigned

Jun 7, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200096000000",
    "number": "1487694535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 COLBY AVE",
            "address_2": "SUITE 203",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982032338",
            "telephone_number": "425-252-8102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 COLBY AVE",
            "address_2": "SUITE 203",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982032338",
            "telephone_number": "425-252-8102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "GARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2008-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "MD00012487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRY",
            "identifier": "0050032",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1067305",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "MD00012487",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kriti Srivastava, MD
• Jamie St Aubin, CMA
• Deborah St Lawrence, RPH
• Karla Geralynn St. Clair, LMP
• Susan K. Stachofsky, RN
• David J Stackhouse, M.D.
• Tiffane Jolene Staley, ARNP, RN
• Mallorie Daleen Stallings
• Shirley Stallings, MD
• Bianca Stamps

• Urology Physician in Everett, WA
• Providers in Everett, WA by specialty
• Urology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.