| Organization Name: | IDAHO REGIONAL HAND & UPPER EXTREMITY CENTER PLLC |
| NPI Number: | 1003157801 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY DEE STUCKI (PRESIDENT) |
| Mailing Address: | 560 Memorial Dr Suite B Pocatello |
| State: | ID US |
| Postal Code: | 832014703 |
| Phone Number: | 2082354263 |
| Fax Number: | 2082334268 |
| NPI Enumeration Date: | 03/05/2013 |
| NPI Last Update Date: | 03/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207XS0106X |
| License Number: | M-8547 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Orthopaedic Surgery |
| Taxonomy Specialization: | Hand Surgery |
| Taxonomy Definition: | An orthopaedic surgeon trained in the investigation, preservation and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist. |