Healthcare Provider Details

I. General information

NPI: 1104952258
Provider Name (Legal Business Name): SUZANNE DASHER STUCKEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SPRINGHILL AVE SUITE 1600
MOBILE AL
36604-3207
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-434-3915
  • Fax: 251-434-3802
Mailing address:
  • Phone: 251-470-5842
  • Fax: 251-470-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27923
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: