Provider Demographics
NPI:1518195213
Name:STUCKY, BRYAN KENT (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:KENT
Last Name:STUCKY
Suffix:
Gender:M
Credentials:MD
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 913041
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-3041
Mailing Address - Country:US
Mailing Address - Phone:610-594-5108
Mailing Address - Fax:610-363-1790
Practice Address - Street 1:911 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846
Practice Address - Country:US
Practice Address - Phone:620-276-8201
Practice Address - Fax:620-276-6468
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7243207Q00000X
KS04-34709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518195213OtherNPI
KS200963170AMedicaid