Provider Demographics
NPI:1962668665
Name:ROBERT STUCKERT III, D.O.
Entity Type:Organization
Organization Name:ROBERT STUCKERT III, D.O.
Other - Org Name:BEVERLY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKERT
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:740-984-1414
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45715-0325
Mailing Address - Country:US
Mailing Address - Phone:740-984-1414
Mailing Address - Fax:740-984-1723
Practice Address - Street 1:531 5TH ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:OH
Practice Address - Zip Code:45715-8916
Practice Address - Country:US
Practice Address - Phone:740-984-1414
Practice Address - Fax:740-984-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty