Provider Demographics
NPI:1891765624
Name:STOCKER, ERIC HERMANN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:HERMANN
Last Name:STOCKER
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 1:1110 N SARAH DEWITT DR
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-3311
Mailing Address - Country:US
Mailing Address - Phone:308-672-3845
Mailing Address - Fax:830-672-4746
Practice Address - Street 1:4125 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1903
Practice Address - Country:US
Practice Address - Phone:210-615-1366
Practice Address - Fax:210-615-8229
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6748207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00898287OtherMEDICARE PTAN
060032836OtherMEDICARE RAILROAD
TX8CM521OtherBCBS
TX129026401Medicaid
TX8CM521OtherBCBS
TX129026407Medicaid
TX80866FMedicare ID - Type UnspecifiedMEDICARE
TXB112456Medicare PIN