Individual
JONATHAN CHARLES UECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 SILVER LAKE RD NW, SUITE 110, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
(651) 628-0411
Mailing address
1900 SILVER LAKE RD NW, SUITE 110, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
(651) 628-0411
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
39702
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260044491
RR MEDICARE
—
05
—
883725200
—
MN
Enumeration date
04/07/2006
Last updated
06/30/2008
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