MEDICARE: MARK O TUCKER MD

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
1	208600000X	Surgery Physician	K7223	TX

General Provider Information

NPI Number	:	1609964394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK O TUCKER MD

Provider Business Mailing Address
First Line	:	6513 PRESTON RD
Second Line	:	SUITE 300
City	:	PLANO
State	:	TX
Zip	:	75024-2688
Country	:	US
Telephone Number	:	972-608-2025
Fax Number	:	972-608-2032

Provider Business Practice Location Address
First Line	:	6513 PRESTON RD
Second Line	:	SUITE 300
City	:	PLANO
State	:	TX
Zip	:	75024-2688
Country	:	US
Telephone Number	:	972-608-2025
Fax Number	:	972-608-2032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/13/2009

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Directions to “ MARK O TUCKER MD” Practice Location

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