Provider Demographics
NPI:1083293534
Name:STUCKER, DARREN PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:PAUL
Last Name:STUCKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:3201 UNIVERSITY DR E STE 425
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3479
Practice Address - Country:US
Practice Address - Phone:979-207-7400
Practice Address - Fax:979-207-7401
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TXPA14623363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ00259715OtherRR MEDICARE
TX425729701Medicaid