Provider Demographics
NPI:1508889205
Name:UECKER, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:UECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1601 TRINITY ST STE 704F
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1765
Mailing Address - Country:US
Mailing Address - Phone:512-324-7873
Mailing Address - Fax:512-380-7503
Practice Address - Street 1:1601 TRINITY ST STE 704F
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1765
Practice Address - Country:US
Practice Address - Phone:512-324-7873
Practice Address - Fax:512-380-7503
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2610208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045761602Medicaid
TX8F8523OtherBCBS
TX8A9239Medicare PIN
TXG93428Medicare UPIN
TX045761602Medicaid