Individual
DR. BRADLEY J STUCKENSCHNEIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
679 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3915
(573) 686-5579
(573) 686-9555
Mailing address
360 S MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63703-4920
(573) 335-3577
(573) 335-1559
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD103265
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112483
BLUE CROSS BLUE SHIELD MO
MO
01
—
223655
HEALTHLINK
—
01
—
P00020957
RAILROAD MEDICARE
—
Enumeration date
03/15/2007
Last updated
07/08/2007
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