Provider Demographics
NPI:1922063106
Name:DRUCKER, MICHAEL STUART (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STUART
Last Name:DRUCKER
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 1:8837 GOODBYS EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4695
Mailing Address - Country:US
Mailing Address - Phone:904-731-7650
Mailing Address - Fax:904-448-0370
Practice Address - Street 1:8837 GOODBYS EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4695
Practice Address - Country:US
Practice Address - Phone:904-731-7650
Practice Address - Fax:904-448-0370
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000581200Medicaid
FLP00649332OtherMEDICARE RR
FLP00649332OtherMEDICARE RR