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General NPI Number Information
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NPI Number | 1427051051
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Entity Type | Individual
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Provider Name | RUCKER STEPHEN MURRY MD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 709 HOLLYBROOK DR STE 4500
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City | LONGVIEW
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State | TX
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Zip | 75605-2412
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Country | US
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Telephone | 903-291-6114
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Fax | 903-291-6229
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Provider Business Mailing Address
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Address Line | PO BOX 610393
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City | DALLAS
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State | TX
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Zip | 75261-0393
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Country | US
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Telephone | 903-757-6042
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Fax | 903-237-1810
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G5973
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License Number State | TX
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