Provider Demographics
NPI:1801087820
Name:BOVARD-STUCKERT, JODY (MD)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:
Last Name:BOVARD-STUCKERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N ELAM AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1142
Mailing Address - Country:US
Mailing Address - Phone:336-854-8800
Mailing Address - Fax:336-299-4308
Practice Address - Street 1:510 N ELAM AVE STE 101
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1142
Practice Address - Country:US
Practice Address - Phone:336-854-8800
Practice Address - Fax:336-299-4308
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200701275207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology