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NPI Code Detail

MEDICARE: BRUCE NICHOLSON TUCKER M.D.

MEDICARE: BRUCE NICHOLSON TUCKER M.D.
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
1207R00000XInternal Medicine PhysicianG44233CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00420858OTHERCARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G442330OTHERBLUE SHIELD OF CALIFORNIA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780677054
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE NICHOLSON TUCKER M.D.
Provider Business Mailing Address
First Line : 3536 MENDOCINO AVE
Second Line : STE 200
City : SANTA ROSA
State : CA
Zip : 95403-3634
Country : US
Telephone Number : 707-575-6049
Fax Number : 707-544-0834
Provider Business Practice Location Address
First Line : 3536 MENDOCINO AVE
Second Line : STE 300
City : SANTA ROSA
State : CA
Zip : 95403-3634
Country : US
Telephone Number : 707-544-3411
Fax Number : 707-544-0834
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2005
Last Update Date : 02/07/2012

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Directions to “ BRUCE NICHOLSON TUCKER M.D.” Practice Location

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