Individual
JORDAN W STUCKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 RALSTON AVE, DEPARTMENT OF SURGERY, DEFIANCE, OH 43512-1396
(419) 783-6944
(419) 783-4416
Mailing address
1200 RALSTON AVE, DEPARTMENT OF SURGERY, DEFIANCE, OH 43512-1396
(419) 783-6944
(419) 783-4416
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35094500
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000637364
ANTHEM
OH
05
—
2994014
—
OH
01
—
97054449
AETNA
OH
01
—
P00812723
RRMC
OH
Enumeration date
01/04/2007
Last updated
11/03/2023
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