Provider Demographics
NPI:1154377810
Name:STUCKEY, TODD W (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:W
Last Name:STUCKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2114 N LINCOLN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1028
Mailing Address - Country:US
Mailing Address - Phone:402-362-5555
Mailing Address - Fax:402-362-7137
Practice Address - Street 1:2114 N LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1028
Practice Address - Country:US
Practice Address - Phone:402-362-5555
Practice Address - Fax:402-362-7137
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE21168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077294513Medicaid
NE21168OtherSTATE LICENSE NUMBER
NEH13416OtherUPIN NUMBER
NE21168OtherSTATE LICENSE NUMBER