Provider Demographics
NPI:1861474090
Name:STOCKER, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:STOCKER
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 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35230207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0704379OtherMEDICA HEALTH PLANS
23509OtherARAZ GROUP AMERICAS PPO
527KOSTOtherBLUE CROSS BLUE SHIELD
FAC#50A61CEOtherBLUE CROSS BLUE SHIELD
MN840798300Medicaid
HP35866OtherHEALTH PARTNERS
518KOSTOtherBLUE CROSS BLUE SHIELD
0252039OtherPREFERRED ONE
FAX#50A45CEOtherBLUE CROSS BLUE SHIELD
112006OtherU CARE
FAC#50A61CEOtherBLUE CROSS BLUE SHIELD
0704379OtherMEDICA HEALTH PLANS