Provider Demographics
NPI:1841729217
Name:STUCKY, BRANDON (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:STUCKY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2356 MEADOWS BLVD STE 140B
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8410
Mailing Address - Country:US
Mailing Address - Phone:303-218-7774
Mailing Address - Fax:303-660-5065
Practice Address - Street 1:2356 MEADOWS BLVD STE 140B
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8410
Practice Address - Country:US
Practice Address - Phone:303-218-7774
Practice Address - Fax:303-660-5065
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-09263207Q00000X
KS04-43043207Q00000X
CODR.74669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine