Provider Demographics
NPI:1861509176
Name:DUCKER, STEPHEN E (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:E
Last Name:DUCKER
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 1:1150 CIELO CT
Mailing Address - Street 2:
Mailing Address - City:NORTH VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34275-2222
Mailing Address - Country:US
Mailing Address - Phone:813-361-6758
Mailing Address - Fax:
Practice Address - Street 1:1150 CIELO CT
Practice Address - Street 2:
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-2222
Practice Address - Country:US
Practice Address - Phone:813-361-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2679832367500000X
FLME117152208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300373600Medicaid
FL430068342OtherRR MEDICARE
FLG2134OtherBCBS
FL430068342OtherRR MEDICARE