MEDICARE: J CRAIG UECKER MD PA

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	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1174898597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J CRAIG UECKER MD PA

Provider Business Mailing Address
First Line	:	3449 JOHNSON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5420
Country	:	US
Telephone Number	:	954-964-4113
Fax Number	:	954-963-8121

Provider Business Practice Location Address
First Line	:	3449 JOHNSON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5420
Country	:	US
Telephone Number	:	954-964-4113
Fax Number	:	954-963-8121

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. WANDA LYNN DITTHARDT
Credential	:
Telephone Number	:	954-964-4113

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	07/18/2012

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