Basic Information
| Provider Information | |||||||||
| NPI: | 1669752770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STUCKEY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | EDWIN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | ATP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 311177 | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781311177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306091200 | ||||||||
| FaxNumber: | 8306091202 | ||||||||
| Practice Location | |||||||||
| Address1: | 1324 COMMON ST STE 304 | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781303566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306091200 | ||||||||
| FaxNumber: | 8306091202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2011 | ||||||||
| LastUpdateDate: | 11/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.