Provider Demographics
NPI:1083857536
Name:STUCKI, JEFFREY DEE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DEE
Last Name:STUCKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 HOSPITAL WAY STE 710
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2745
Mailing Address - Country:US
Mailing Address - Phone:208-235-4263
Mailing Address - Fax:208-233-4268
Practice Address - Street 1:444 HOSPITAL WAY STE 710
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2745
Practice Address - Country:US
Practice Address - Phone:208-234-4263
Practice Address - Fax:208-233-4268
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.001617207X00000X
IDO-0574207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
20003824Medicare UPIN