MEDICARE: ROBERT E 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	207X00000X	Orthopaedic Surgery Physician	R1A62	MO

General Provider Information

NPI Number	:	1831186287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT E TUCKER MD

Provider Business Mailing Address
First Line	:	505 COUCH AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-5577
Country	:	US
Telephone Number	:	314-966-0111
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 COUCH AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-5577
Country	:	US
Telephone Number	:	314-966-0111
Fax Number	:

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	08/22/2019

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