Provider Demographics
NPI:1083967707
Name:STUCKER, CLAY DONATHAN (CSFA)
Entity Type:Individual
Prefix:MR
First Name:CLAY
Middle Name:DONATHAN
Last Name:STUCKER
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3025
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3025
Mailing Address - Country:US
Mailing Address - Phone:713-271-2384
Mailing Address - Fax:281-833-8950
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:1610
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-271-2384
Practice Address - Fax:281-833-8950
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137689246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant