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NPI Code Detail

MEDICARE: JAMES ROBERT TUCKER CRNA

MEDICARE: JAMES ROBERT TUCKER CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist1-084210AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-084210OTHERALALABAMA BOARD OF NURSING
2051524147OTHERALBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346254943
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES ROBERT TUCKER CRNA
Provider Business Mailing Address
First Line : 1200 W MAPLE AVE
Second Line :
City : GENEVA
State : AL
Zip : 36340-1642
Country : US
Telephone Number : 334-684-3655
Fax Number :
Provider Business Practice Location Address
First Line : 1200 W MAPLE AVE
Second Line :
City : GENEVA
State : AL
Zip : 36340-1642
Country : US
Telephone Number : 334-684-3655
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 07/09/2007

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