MEDICARE: DR. JOSHUA SHEPARD KUCKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	M1853	TX
2	207P00000X	Emergency Medicine Physician	A98059	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336103324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA SHEPARD KUCKER MD

Provider Business Mailing Address
First Line	:	PO BOX 977
Second Line	:
City	:	WINDSOR
State	:	CA
Zip	:	95492-0977
Country	:	US
Telephone Number	:	904-307-3440
Fax Number	:

Provider Business Practice Location Address
First Line	:	179 BOUQUET CIR
Second Line	:
City	:	WINDSOR
State	:	CA
Zip	:	95492-9607
Country	:	US
Telephone Number	:	904-307-3440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	12/15/2021

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