Individual
DR. LESLIE M STUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15052
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150525
—
SC
01
—
SC7755A105
MEDICARE
SC
Enumeration date
03/28/2006
Last updated
03/30/2018
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