Healthcare Provider Details

I. General information

NPI: 1053471912
Provider Name (Legal Business Name): STEVEN B TUCKER MD FACP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 PROVIDENCE DR SUITE 304
ANCHORAGE AK
99508-4616
US

IV. Provider business mailing address

3300 PROVIDENCE DR-#304
ANCHORAGE AK
99508-4621
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-4840
  • Fax: 907-212-4820
Mailing address:
  • Phone: 907-770-2380
  • Fax: 907-770-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STEVEN B TUCKER
Title or Position: OWNER PHYSICIAN
Credential: M.D.
Phone: 907-212-4840