Healthcare Provider Details

I. General information

NPI: 1457347130
Provider Name (Legal Business Name): JOHN PATRICK TUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406A TAYLOR ST
SCOTTSBORO AL
35768-2424
US

IV. Provider business mailing address

406A TAYLOR ST
SCOTTSBORO AL
35768-2424
US

V. Phone/Fax

Practice location:
  • Phone: 256-574-1050
  • Fax: 256-574-1045
Mailing address:
  • Phone: 256-574-1050
  • Fax: 256-574-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16639
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: