MEDICARE: ERIC HERMANN STOCKER MD

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	207RC0000X	Cardiovascular Disease Physician	J6748	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00898287	OTHER	TX	MEDICARE PTAN
2	060032836	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	8CM521	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1891765624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC HERMANN STOCKER MD

Provider Business Mailing Address
First Line	:	1110 N SARAH DEWITT DR
Second Line	:
City	:	GONZALES
State	:	TX
Zip	:	78629-3311
Country	:	US
Telephone Number	:	308-672-3845
Fax Number	:	830-672-4746

Provider Business Practice Location Address
First Line	:	4125 MCCULLOUGH AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-1903
Country	:	US
Telephone Number	:	210-615-1366
Fax Number	:	210-615-8229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	01/15/2020

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Directions to “ ERIC HERMANN STOCKER MD” Practice Location

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