Provider Demographics
NPI:1649493560
Name:STECKLER, JR., DAVID ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:STECKLER, JR.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13582
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-3582
Mailing Address - Country:US
Mailing Address - Phone:769-300-4055
Mailing Address - Fax:601-427-5864
Practice Address - Street 1:200 W JACKSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:769-300-4055
Practice Address - Fax:601-427-5864
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19109174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist