Provider Demographics
NPI:1396740445
Name:STUCKERT, ROBERT III (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:STUCKERT
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006102S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHW06102OtherHEALTH PLAN UPPER OH VALL
OH201582447001OtherBCBS MTN STATE
OH000000346859OtherBCBS ANTHEM
OH0110570Medicaid
OH7380139OtherCIGNA
OH4573606OtherAETNA
OH0110570Medicaid
OH0773776Medicare ID - Type Unspecified
OH201582447001OtherBCBS MTN STATE