Provider Demographics
NPI:1356614218
Name:GERALD E. STACK M.D., APMC
Entity type:Organization
Organization Name:GERALD E. STACK M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-924-0244
Mailing Address - Street 1:8786 GOODWOOD BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8786 GOODWOOD BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7917
Practice Address - Country:US
Practice Address - Phone:225-924-0244
Practice Address - Fax:225-924-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1338591Medicaid