Healthcare Provider Details

I. General information

NPI: 1174898597
Provider Name (Legal Business Name): J CRAIG UECKER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 JOHNSON ST
HOLLYWOOD FL
33021-5420
US

IV. Provider business mailing address

3449 JOHNSON ST
HOLLYWOOD FL
33021-5420
US

V. Phone/Fax

Practice location:
  • Phone: 954-964-4113
  • Fax: 954-963-8121
Mailing address:
  • Phone: 954-964-4113
  • Fax: 954-963-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. WANDA LYNN DITTHARDT
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-964-4113