Provider Demographics
NPI:1659386308
Name:STOECKER, WILLEFORD J (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLEFORD
Middle Name:J
Last Name:STOECKER
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 1:70 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4928
Mailing Address - Country:US
Mailing Address - Phone:573-334-6071
Mailing Address - Fax:573-334-4739
Practice Address - Street 1:70 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4928
Practice Address - Country:US
Practice Address - Phone:573-334-6071
Practice Address - Fax:573-334-4739
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3G342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
207350OtherHEALTHLINK
AR143790001Medicaid
MO185214OtherMO BLUE CROSS BLUE SHIELD
MO202662102Medicaid
IL036-074663OtherIL BLUE CROSS BLUE SHIELD
063896OtherHEALTH ALLIANCE
430954380CAPOtherMERCY HEALTH PLAN
063896OtherHEALTH ALLIANCE
MO202662102Medicaid
A27465Medicare UPIN
ILL08660Medicare ID - Type UnspecifiedIL MEDICARE
AR143790001Medicaid