Healthcare Provider Details

I. General information

NPI: 1508396938
Provider Name (Legal Business Name): DAVID PAUL STUCKI CO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 EVERGREEN DR
OAKLAND ME
04963-5364
US

IV. Provider business mailing address

11 PERENNIAL WAY
OAKLAND ME
04963-5240
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-2240
  • Fax: 207-872-7471
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO004327
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: