Provider Demographics
NPI:1104919851
Name:STOECKER, WILLIAM V (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:V
Last Name:STOECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 STOLTZ DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-7714
Mailing Address - Country:US
Mailing Address - Phone:573-364-0122
Mailing Address - Fax:573-364-0129
Practice Address - Street 1:10101 STOLTZ DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-7714
Practice Address - Country:US
Practice Address - Phone:573-364-0122
Practice Address - Fax:573-364-0129
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9056207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0320000OtherUNITED HEALTHCARE PROVIDE
MO201026515Medicaid
MO506121300Medicaid
MO4358OtherBLUE CROSS PROVIDER #
MO117841OtherHEALTHLINK PROVIDER #
MO201026515Medicaid
MO506121300Medicaid
MOE05013Medicare UPIN